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									                  MARINE ORDERS

                                      Part 9

              Health Medical Fitness

                                     Issue 5



                                  Order No 22 of 1999


Pursuant to Section 425(1AA) of the Navigation Act 1912, I hereby make this Order
repealing Marine Orders, Part 9, Issue 4, and issuing Marine Orders, Part 9, Issue 5, to
come into operation on 3 February 2000.


                                                             Clive Davidson
                                                             Chief Executive Officer
                                                             24 December 1999
PART 9                                                              MEDICAL FITNESS
Issue 5                                                               OF SEAFARERS


                                    Table of Contents
1     Interpretation
2     Purpose and application
3     Review of decisions
4     Penal provisions
5     Requirement to be medically fit
6     Evidence of medical fitness
7     Certificate of Medical Fitness
8     Aids to vision or hearing


Appendix 1 Medical certificate evidencing fitness for work in a sea-going vessel
Appendix 2 Guidelines for the medical examination of seafarers and coastal pilots
Appendix 3 Job task analyses
Appendix 4 Forms
Appendix 5 Guidance in screening for colour vision




Previous issues
Issue 1, Order No 6 of 1983
Issue 2, Order No 5 of 1985
Issue 3, Order No 5 of 1988
Issue 4, Order No 1 of 1993
—Amended by Order No 4 of 1993



(i)                                                                  Order No 22 of 1999
MEDICAL FITNESS                                                                       PART 9
OF SEAFARERS                                                                           Issue 5



                                  1 Interpretation
1.1 In this Part, unless the contrary intention appears, the following definitions
apply:

AMSA means the Australian Maritime Safety Authority;

applicant means a person who applies for a Certificate of Medical Fitness under
7.1;

Certificate of Medical Fitness means a Certificate of Medical Fitness issued in
accordance with this Part;

coastal pilot means a person who is performing, or intends to perform, the duties
of a licensed pilot for the purposes of Part VIIA of the Great Barrier Reef Marine
Park Act 1975;

holder, in relation to a certificate, means the person identified as holder by that
certificate;

Manager means the Manager, Ship Operations and Qualifications, in AMSA, or
in respect of any particular function, a suitably qualified person appointed by the
Manager, Ship Operations and Qualifications, to carry out that function;

seafarer means a person serving or intending to serve on a ship to which Part II of
the Navigation Act applies and includes a master, officer or seaman but does not
include a pilot, a person who is not a member of the crew of the ship, a
supernumerary, or special personnel as defined in section 283 of the Navigation
Act;

sea-going vessel, for the purposes of the ILO Convention, means:
    (a) a trading ship on an overseas or interstate voyage; or
    (b) a trading ship of 500 tons gross tonnage or more on a voyage:
             (i) that is not an overseas or interstate voyage; and
             (ii) in the course of which it is not at all times capable, at normal
                  operating speed, of returning to its port of departure in 6 hours or
                  less or reaching its intended next port of call in 6 hours or less;

seaman includes a person engaged on a ship in a trainee capacity, other than a sail
trainee as defined in Marine Orders, Part 52;

STCW Code means the Code referred to in the STCW Convention;

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PART 9                                                                     MEDICAL FITNESS
Issue 5                                                                      OF SEAFARERS


STCW Convention means the International Convention on Standards of Training,
Certification and Watchkeeping for Seafarers, 1978, as amended;

the ILO Convention means the Medical Examination (Seafarers) Convention
1946 adopted by the General Conference of the International Labour Organization
on 29 June 1946; and

valid, in relation to a certificate, means a certificate that is current and that has not
been cancelled.
1.2 In this Part:
    (a) headings and sub-headings are part of the Part;
    (b) each Appendix is part of the Part;
    (c) a note included in the text and printed in italics is not part of the Part.

                           2 Purpose and application
2.1 Purpose
This Part:
    (a) for the purposes of subsection 15(2) of the Navigation Act 1912, prescribes
        matters relating to the health of persons performing, or intending to
        perform, the duties of a qualified master, officer or seaman;
    (b) for the purposes of section 124 of the Navigation Act 1912, makes
        provision for and in relation to the medical examination of, and the issue of
        certificates to, masters and seamen and persons proposing to engage in
        employment as masters or seamen; and
    (c) for the purposes of section 134 of the Navigation Act 1912, makes
        provision for and in relation to giving effect to the ILO Convention.
    (e) for the purposes of section 186C of the Navigation Act 1912, makes
        provision for and in relation to the health of pilots;
    (f) gives effect to regulation I/9 annexed to the STCW Convention and section
        B-I/9 of the STCW Code.

2.2 Application
This Part applies to:
   (a) a person employed, or proposing to engage in employment, on a ship to
       which section 124 of the Navigation Act applies;
    (b) a person performing, or intending to perform, the duties of a coastal pilot;



2                                                                           Order No 22 of 1999
MEDICAL FITNESS                                                                     PART 9
OF SEAFARERS                                                                         Issue 5


    (c) a person employed, or proposing to engage in employment, on a sea-going
        vessel registered in Australia:
          (i) that is not a ship to which section 124 of the Navigation Act applies;
              and
          (ii) in respect of which a law of a State or of the Northern Territory does
               not give effect to the ILO Convention; and
    (d) an applicant for the issue or revalidation of certificates under Marine
        Orders, Part 3.

                              3 Review of decisions
3.1 Reviewable decisions

Application may be made to the Administrative Appeals Tribunal for review of a
decision by the Manager:
    (a) requiring a person to obtain a new Certificate of Medical Fitness under
        7.5.2 or 7.5.3;
    (b) refusing to accept a certificate as equivalent under 7.10.3.
3.2 Statement to accompany notices
If a person making a decision referred to in 3.1 gives to a person whose interests
are affected by the decision notice in writing of the decision, the notice must:
    (a) include a statement to the effect that, if the person is dissatisfied with the
        decision, application may, subject to the Administrative Appeals Tribunal
        Act 1975, be made to the Administrative Appeals Tribunal for review of
        the decision; and
    (b) except where subsection 28(4) of that Act applies, also include a statement
        to the effect that the person may request a statement under section 28 of
        that Act.
3.3 Validity of decisions

Failure to comply with 3.2 in relation to a decision does not affect the validity of
that decision.




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PART 9                                                                   MEDICAL FITNESS
Issue 5                                                                    OF SEAFARERS


                               4 Penal provisions
Provisions 5.1, 5.2, 5.3, 7.8, 7.9 and 8 are penal provisions.

    Note: Regulation 4 of the Navigation (Orders) Regulations provides:
    ‘4. A person who contravenes a provision of an order made under subsection
    425(1AA) of the Act that is expressed to be a penal provision is guilty of an
    offence and is punishable on conviction:
    (a) if the offender is a natural personby a fine not exceeding $2,000; or
    (b) if the offender is a body corporateby a fine not exceeding $5,000.


                        5 Requirement to be medically fit
5.1 A person must not perform duties as a seafarer, or be taken into employment
to perform duties as a seafarer, on a ship to which section 124 of the Navigation
Act applies unless that person is medically fit to perform those duties.

5.2 A person must not perform the duties of a coastal pilot unless that person is
medically fit to perform those duties.

5.3 A person must not be employed on a sea-going vessel registered in Australia:
    (a) that is not a ship to which section 124 of the Navigation Act applies; and
    (b) in respect of which a law of a State or of the Northern Territory does not
        give effect to the ILO Convention;
unless that person is medically fit for that employment.

                          6 Evidence of medical fitness
6.1 A person is medically fit for the purposes of 5.1 or 5.2 if that person:
     (a) has a valid Certificate of Medical Fitness; and
     (b) there is no evidence that his or her medical condition has altered since the
         previous medical examination to an extent that would make him or her
         unfit for the duties to be performed.
6.2 A person is medically fit for the purposes of 5.3 if that person:
     (a) has a valid:




4                                                                        Order No 22 of 1999
MEDICAL FITNESS                                                                       PART 9
OF SEAFARERS                                                                           Issue 5


          (i) Certificate of Medical Fitness; or
          (ii) certificate issued by a qualified medical practitioner in accordance
               with Appendix 1; and
    (b) there is no evidence that his or her medical condition has altered since the
        previous medical examination to an extent that would make him or her
        unfit for the duties to be performed.

                        7 Certificate of Medical Fitness
7.1 Application for Certificate of Medical Fitness
A person requiring a Certificate of Medical Fitness must apply to a Medical
Inspector of Seamen.

   Note: Under s.123 of the Navigation Act, Medical Inspectors of Seamen are
   appointed by AMSA. No person will be appointed unless he or she is
   registered as a medical practitioner in a State or Territory of Australia.
   Preference is given to a person who either has a Fellowship of the
   Australasian Faculty of Occupational Medicine (AFOM), or is a trainee of
   AFOM and works under the direct supervision of a Fellow. The names of
   Medical Inspectors of Seamen may be obtained from any AMSA office.

7.2 Medical examination etc
A Medical Inspector of Seamen is to conduct such examinations, tests and
interviews and make such enquires in relation to an applicant as appear
appropriate to determine whether the applicant is medically fit to perform the
intended duties as a seafarer or as a coastal pilot on a ship.

7.3 Determination of fitness
7.3.1 In determining if an applicant is medically fit, a Medical Inspector of
Seamen must, in addition to applying normal medical fitness considerations, have
regard to the Guidelines for the Medical Examination of Seafarers, set out in
Appendix 2 and the job task analyses set out in Appendix 3.

   Note: Where an employer has additional fitness requirements for particular
   duties or voyages (such as for the handling of specific cargoes or voyages to
   the Antarctic), the employer should advise the Medical Inspector of Seamen
   of those requirements and request a supplementary report against them.




Order No 22 of 1999                                                                         5
PART 9                                                                        MEDICAL FITNESS
Issue 5                                                                         OF SEAFARERS


7.3.2 If a person has been declared unfit for duty at sea, that person or his or her
employer may apply for further examination by an independent panel of medical
practitioners, of whom one must be an occupational physician and one a specialist
physician/surgeon from the appropriate specialty.

    Note: The seafarer may bring further evidence of fitness for duty at sea,
    including medical reports from treating medical practitioners, for
    consideration by the independent panel.

7.4 Issue of Certificate of Medical Fitness
7.4.1 If a Medical Inspector of Seamen:
     (a) is satisfied as to the identity of an applicant;
     (b) is able to attest to the true state of the applicant‟s health; and
     (c) determines that the applicant is medically fit to perform the proposed
         duties,
he or she is to issue to the applicant a Certificate of Medical Fitness in accordance
with Form 1 in Appendix 4.

7.4.2 If a Medical Inspector of Seamen:
     (a) is satisfied as to the identity of an applicant;
     (b) is able to attest to the true state of the applicant‟s health; and
     (c) determines that the applicant is medically fit to perform duties other than
         those proposed,
he or she may issue to the applicant a Certificate of Medical Fitness in accordance
with Form 1 in Appendix 4, endorsed to indicate the duty or duties for which the
applicant is medically fit.

7.5 Further examination

7.5.1 A person who is refused a Certificate of Medical Fitness may make a second
application.
7.5.2 A seafarer who is the holder of a valid Certificate of Medical Fitness may at
any time be required by the owner or master of a ship, or by the Manager, to
obtain a new certificate where as a result of illness, injury or other cause it is
believed the seafarer may no longer meet the standards specified in this Part.




6                                                                             Order No 22 of 1999
MEDICAL FITNESS                                                                      PART 9
OF SEAFARERS                                                                          Issue 5


7.5.3 A coastal pilot who is the holder of a valid certificate of medical fitness may
at any time be required by the Manager to obtain a new certificate where as a result of
illness, injury or other cause it is believed the coastal pilot may no longer meet the
standards specified in this Part.

7.6 Period of validity of Certificate of Medical Fitness
7.6.1 Except as provided in 7.6.2, 7.6.3, 7.6.5 and 7.6.6, and subject to 7.7, a
Certificate of Medical Fitness is valid from the date of issue for a period of 2
years.
7.6.2 Subject to 7.7, a Certificate of Medical Fitness in respect of a person who on
the date of issue was:
    (a) less than 17 years of age; or
    (b) 54 years of age or more,
is valid from the date of issue for a period of one year.

7.6.3 An expired Certificate of Medical Fitness may be extended by the Manager
for a period of 3 months from the date of its expiry if the holder is to be employed
on a ship and;
    (b) the holder is unable to be issued with a new Certificate of Medical Fitness
        in accordance with this Part prior to the ship being taken to sea; and
    (c) the expired Certificate of Medical Fitness has not already been extended by
        virtue of this provision.

7.6.4 A Certificate of Medical Fitness extended under 7.6.3 is not valid for use by
a coastal pilot.

7.6.5 If the period of validity of a Certificate of Medical Fitness expires during
the course of a voyage, the Certificate of Medical Fitness continues to be valid
until the end of that voyage, except for use by a coastal pilot.

7.6.6 A Certificate of Medical Fitness may be issued for less than the full period if
the Medical Inspector of Seamen considers it appropriate.

   Note: An example might be where a Medical Inspector of Seamen considers
   that a person, although fit at the time of the examination, needs to be re-
   examined to determine the continued efficacy of treatment for a condition.




Order No 22 of 1999                                                                        7
PART 9                                                                  MEDICAL FITNESS
Issue 5                                                                   OF SEAFARERS


7.7 Cancellation
A Certificate of Medical Fitness is deemed to be cancelled when the person to
whom it is issued:
   (a) is issued with a later Certificate of Medical Fitness; or
    (b) is required in accordance with 7.5.2 or 7.5.3 to obtain a further Certificate
        of Medical Fitness.

7.8 Production of Certificate of Medical Fitness

A person required by Marine Orders to be the holder of a valid Certificate of
Medical Fitness must not fail, except with reasonable excuse, to produce the
certificate on demand to the owner or master of a ship on which the person serves
or intends to serve, or to a surveyor.

7.9 Delivery of cancelled Certificate of Medical Fitness

A person whose Certificate of Medical Fitness is deemed to be cancelled under 7.7
must deliver the Certificate of Medical Fitness to the Manager on demand.

7.10 Issue of certificate for purposes of STCW Convention

7.10.1 If a Medical Inspector of Seamen determines that a person who, at the time
of the examination does not qualify for the issue of a Certificate of Medical
Fitness, meets the standards in Appendix 2 relating to eyesight, colour vision and
hearing, the Medical Inspector of Seamen may issue that person with a certificate
in accordance with Form 2 in Appendix 4 for the purposes of issue or revalidation
of a certificate under Marine Orders, Part 3.

7.10.2 A certificate issued under 7.10.1 is valid from the date of issue for a period
of 5 years.

7.10.3 A certificate accepted by the Manager as being equivalent to a certificate
issued under 7.10.1 is deemed to be valid for the period specified in the certificate
or for 5 years, whichever is the less.

                         8 Aids to vision or hearing
A seafarer or coastal pilot whose Certificate of Medical Fitness indicates that an
aid to vision or hearing was used for the purpose of being found fit must at all
times when on duty on a ship use such aid or aids and, in the case of an aid to
vision, keep a spare aid to vision available.



8                                                                        Order No 22 of 1999
MEDICAL FITNESS                                                                       PART 9
OF SEAFARERS                                                                           Issue 5




                                         Appendix 1

                      Medical certificate evidencing fitness
                         for work in a sea-going vessel
1. A medical certificate in respect of a person may only be issued by a duly qualified
medical practitioner who, being satisfied after conducting such examinations, tests and
interviews and making such enquires in relation to the person as appear appropriate, is
satisfied that the person is medically fit to serve on a ship.

2. In deciding on fitness for service, the medical practitioner is, in addition to normal
medical fitness considerations, to have regard to the age of the person and the nature of
the duties to be performed.

3. A medical certificate is to attest:
    (a) that the hearing and sight of the person and, in the case of a person to be
        employed in the deck department, colour vision, are all satisfactory;
    (b) that the person is not suffering from any disease likely to be aggravated by, or to
        render the person unfit for, service at sea or likely to endanger the health of
        other persons on board.

4. A medical certificate is to remain in force for a period not exceeding 2 years from
the date on which it was granted.

5. Colour vision needs to be examined only every 6 years.

6. If the period of validity of a medical certificate expires in the course of a voyage,
the certificate is to continue in force until the end of that voyage.

7. A person who has been refused a medical certificate is entitled to a second
examination by a medical practitioner who is independent of any shipowner or of any
organisation of shipowners or seafarers.

8. A person who is the holder of a valid medical certificate may at any time be
required by the owner or master of a ship to obtain a new certificate where as a result of
illness, injury or other cause it is believed the person may no longer meet appropriate
minimum standards.

                                          *****




Order No 22 of 1999                                                                         9
PART 9                                                            MEDICAL FITNESS
Issue 5                                                             OF SEAFARERS




                                      Appendix 2
                         Guidelines for the medical examination
                             of seafarers and coastal pilots

                                          Contents

How to use these guidelines
Part A Seafaring and medical fitness

1.        Introduction
     - Why is fitness important?
     - The work environment of seafarers

2.        Procedures
     - Frequency of health assessment
     - What information goes to the employer, AMSA and the seafarer?
     - Health assessment outcomes
       Right of appeal and medical panels

3.        Forms

Part B Medical standards

1.        Overview

2.        Obesity
     - Body morphology

3.        Eyes/vision
     - visual acuity
     - colour vision
     - Table 1: Seafarers‟ visual standard

4.        Hearing, ear, nose and throat
     - Hearing standard


Order No 22 of 1999                                                            10
MEDICAL FITNESS                       APPENDIX 2                          PART 9
OF SEAFARERS                           (continued)                         Issue 5


     - Table 2: Minimum standards of Hearing for Deck and Engine Departments
     - The conduct of the conversation test
     - Other ear, nose and throat conditions

5.     Cardiovascular
     - Ischaemic heart disease
     - Arrhythmia/pacemaker
     - Valvular heart disease
     - Cardiomyopathy
     - Aneurysms
     - Hypertension
     - Congenital heart disease
     - Peripheral circulation
     - Pulmonary circulation

6.     Respiratory
     - Pneumothorax
     - Asthma
     - Reduced lung function
     - Tuberculosis
     - Chest X-rays

7.     Gastrointestinal
     - Teeth and gums
     - Peptic ulcer
     - Liver and pancreas
     - Gall bladder disease
     - Hernia
     - Colostomies
     - Enteric diseases

8.     Genitourinary



Order No 22 of 1999                                                            11
PART 9                                  APPENDIX 2                       MEDICAL FITNESS
Issue 5                                  (continued                        OF SEAFARERS


9.        Neurological system
      - Epilepsy
      - Migraine
      - Stroke
      - Transient ischaemic attacks (TIAs)
      - Neuromuscular Disorders including Multiple Sclerosis, Parkinsonism

10.       Psychiatric conditions

11.       Prescribed medication, drugs and alcohol
      - Prescribed drugs
      - Table 3: Classes of drugs with potential to affect an individual‟s skills to operate
         ships, boats, plant and equipment, including cranes
      - Illegal drugs
      - Alcohol

12.       Musculoskeletal
13.       Diabetes and endocrine
      - Diabetes mellitus
      - Thyroid disease
      - Adrenal disease

14.       Skin disorders
      - Infections
      - Dermatoses

15.       Haemopoietic

16.       Infectious diseases

17.       Neoplasms




12                                                                        Order No 22 of 1999
MEDICAL FITNESS                        APPENDIX 2                                  PART 9
OF SEAFARERS                            (continued)                                 Issue 5


                             How to use these guidelines
These guidelines should be read in full, at least once, at the time of issue.

When a seafarer presents for a medical:


     1.      Turn to the job task analysis in Appendix 3 to refresh your memory.

     2.      Examine the person and note any abnormalities on either history or
             physical examination.

     3.      If any abnormalities are detected, refer to the appropriate section in
             the guidelines.

     4.      Complete the Certificate of Medical Fitness and make appropriate
             follow-up and referral arrangements for seafarers found to be
             temporarily or permanently unfit for duties.
     5.      If unclear about administrative procedures, contact the Manager, Ship
             Operations and Qualifications at the Australian Maritime Safety
             Authority on: 1800 021 098.


                      Part A Seafaring and Medical Fitness
                                    1 Introduction

Marine Orders, Part 9 (Medical Fitness of Seafarers) is administered by the Australian
Maritime Safety Authority. Part 9 makes provision for the issue of Certificates of
Medical Fitness for duty at sea of seafarers (masters, mates, engineers and integrated
ratings) and gives effect to Article 3 of ILO convention 73.

These guidelines have been compiled for the use of Medical Inspectors who are
assessing an individual‟s fitness to work at sea. The medical fitness standards have
been developed in relation to the basic job task analyses in Appendix 3. An employing
company may have more stringent guidelines developed by its own occupational
physician. Such guidelines will depend on the nature of the jobs and any specific
equipment operated. Where such guidelines exist, they should be followed.




Order No 22 of 1999                                                                     13
PART 9                                  APPENDIX 2                       MEDICAL FITNESS
Issue 5                                  (continued                        OF SEAFARERS


While the final judgement on whether or not an applicant is fit to work in a particular
job at sea rests with the Medical Inspector, these guidelines draw attention to those
conditions that have the potential to present a high level of risk in some circumstances.

1.1 Why is fitness important?

1.1.1 Employers have a duty of care to provide a safe work environment and protect
the health, safety and welfare of employees. Employees similarly have a duty of care
for their own safety and that of the people they work with and the community. Medical
assessment of fitness is one aspect of meeting this duty of care.

1.1.2 The primary objectives of a medical assessment of fitness for duty at sea are:


          to ensure that individuals are fit to perform the essential tasks of
          their job at sea effectively

                                          and

          to anticipate and, where possible, prevent the avoidable
          occurrence of ill-health offshore which could place individuals,
          their colleagues and emergency personnel at risk.

1.1.3 Medical conditions may impinge on work in the following areas:
     (a) the condition may limit, reduce or prevent an individual from performing the
         job effectively eg loss of mobility and dexterity making engine room work and
         other maintenance tasks difficult;
     (b) the condition may be made worse by the job eg an asthmatic exposed to
         allergens on a grain ship;
     (c) the condition may make it unsafe for the person to do the job eg liability to
         sudden loss of consciousness whilst transferring from a smaller vessel to a
         larger vessel by climbing a rope ladder;
     (d) the condition is likely to make it unsafe both for the individual and other crew
         eg a ships crane operator liable to sudden loss of consciousness; catering crew
         with infectious hepatitis or gastro-enteritis;
     (e) the condition is likely to make it unsafe for other shipping eg a master or mate
         who is at risk of sudden loss of consciousness due to a cardiac arrhythmia;
     (f) the condition, if it worsens, is one which will require emergency evacuation
         for medical treatment eg gastric ulcer haemorrhage.

14                                                                        Order No 22 of 1999
MEDICAL FITNESS                        APPENDIX 2                                  PART 9
OF SEAFARERS                            (continued)                                 Issue 5


1.2 The work environment of seafarers

1.2.1 Medical Inspectors should bear in mind the aspects of seafaring life, listed below,
when assessing fitness for duty at sea.

1.2.2 As ships often operate far offshore or in inaccessible areas, it is often difficult to
replace seafarers who become injured or ill. Many ships have only the minimal number
of persons on board necessary to operate the ship; thus the incapacitation of even one
seafarer may place a substantial additional burden on his or her shipmates.

1.2.3 Ships‟ officers generally receive basic first-aid and other medical training, and
ships are usually equipped with basic medical supplies. Nevertheless, it is often quite
difficult to transport sick or injured seafarers ashore where they can be treated by
qualified physicians. In some geographical areas, the closest medical care ashore may
be well below the standard of the seafarer‟s home country. It is therefore inadvisable
and often unsafe to allow persons with certain medical conditions to become seafarers
or to return to seagoing employment.

1.2.4 Seafarers live close to each other at sea, often for long periods. Contagious
diseases therefore may be a serious threat, endangering not only the health of other
seafarers but also the safety of the ship and, where carried, passengers. It is particularly
important that seafarers concerned with the preparation of food do not suffer from
conditions which may be transmitted to others through their work.

1.2.5 Seafarers should be medically fit to perform their normal duties correctly and to
be able to respond to emergency situations (eg fighting fires, lowering lifeboats,
assisting passengers).

1.2.6 Seafarers should be able to adjust to the often violent motions of the ship, to be
able to live and work in sometimes cramped spaces, to be able to climb ladders, to lift
heavy weights and to be able to withstand exposure to harsh weather conditions on
deck or excessive heat in the machinery spaces. They should not suffer from conditions
which are exacerbated by air travel.

1.2.7 Seafarers should be able to live and work closely with the same people for weeks
and perhaps months on end and under occasionally stressful conditions. They should
be capable of dealing effectively with isolation from family and friends and, in some
cases, from persons of their own cultural background.

1.2.8 Shipping operations and shipboard duties vary substantially. For a fuller
understanding of physical demands of particular categories of work on board ship, the
Medical Inspector should consult the employer.



Order No 22 of 1999                                                                     15
PART 9                                  APPENDIX 2                        MEDICAL FITNESS
Issue 5                                  (continued                         OF SEAFARERS


                                      2 Procedures
2.1 Frequency of health assessments

2.1.1 All seafarers and coastal pilots should be assessed as to medical fitness for duties
at sea:
         less than 18 years of age: annually
         18 - 54 years of age: two-yearly
         55 years of age and over: annually with resting ECG (stress ECG, if in safety
          critical job and clinically indicated)
         if there is a change in the medical condition of the employee
         after prolonged sickness absence of 3 months or more due to injury or illness.

2.2 What information goes to the employer, AMSA and the seafarer?

Confidentiality

2.2.1 The employer, AMSA and the applicant/seafarer will receive a copy of the
Certificate of Medical Fitness.

2.2.2 The Medical Inspector (or successor) should keep all the medical examination
forms, including results of investigations in a confidential file, for a period of at least
30 years. This information is not to be released to any person, agency or employer
without a signed consent form or as required by law.

2.3 Health assessment outcomes

2.3.1 An applicant or seafarer is either fit for the intended duties at sea or unfit.

2.3.2 Those declared unfit may be temporarily or permanently unfit or may be fit for
duties other than the intended duties.

2.3.3 If temporarily unfit, the Medical Inspector should specify a minimum period after
which the assessment can be reviewed.

                                         3 Forms
The form of the Certificate of Medical Fitness is prescribed as Form 1 in Appendix 3 to
Marine Orders, Part 9. Other forms that may be found useful are attached to these
guidelines.



16                                                                         Order No 22 of 1999
MEDICAL FITNESS                       APPENDIX 2                                  PART 9
OF SEAFARERS                           (continued)                                 Issue 5


                            Part B Medical Standards

                                     1 Overview
1.1 This section provides information and guidance on medical conditions which may
affect individuals in the safe performance of their duties at sea.

1.2 The medical standards attempt to be specific and give examples of tasks/jobs
which may be affected. The standards cannot cover every clinical situation and the
Medical Inspector should exercise judgement in relation to the key objective -
maintaining safety. For example, could the condition cause sudden loss of control of a
ship, or sudden loss of consciousness when working at heights, or interfere with the
performance of emergency duties?

1.3 Medical Inspectors should make a comprehensive medical assessment of overall
health in the knowledge that errors or omissions of a critical task in some jobs can lead
to serious consequences in terms of human health and life, environmental impact and/or
major property loss.

1.4 The critical time needed for treatment/access to appropriate land-based care is also
a consideration when determining fitness.

1.5 Medical Inspectors of Seafarers should consider what medical conditions could
increase the probability of poor performance of critical tasks, and the probability and
severity of the consequences when determining “Is this applicant medically fit for
duty at sea?”.

                                      2. Obesity
Body morphology

2.1 As obesity can hamper evacuation procedures, persons with a body mass index of
more than 30 kg/m2 should be able to demonstrate that they can climb ladders and fit
through hatches. An Occupational Physician or an Occupational Therapist may need to
conduct a functional assessment on board ship.

2.2 A body mass index of more than 35 kg/m2 presents a high risk. Applicants in this
category may need to undertake weight reduction and be reassessed. It should be noted
that sleep apnoea is more common in those with morbid obesity, as are diabetes and
hypertension.




Order No 22 of 1999                                                                    17
PART 9                                   APPENDIX 2                      MEDICAL FITNESS
Issue 5                                   (continued                       OF SEAFARERS


                                     3. Eyes / vision
Visual acuity
3.1 Far vision is required for:
    (a) watchkeeping duties; and
    (b) control of ships, ships‟ small craft and cranes.
3.2 Near vision is required to read charts, weather maps, computer screens, monitors
and instructions.
3.3 Night and depth vision are required for watchkeeping and control of the ship;
(depth vision is especially important for operating cranes at close distances).

Colour vision
3.4 Good colour vision is required for bridge watchkeeping duties to distinguish red
and green port and starboard channel markers, navigation beacons and ships‟
navigation lights. The ability to identify red, green and white navigation lights is an
essential part of the job for masters, deck officers and seamen required to carry out
lookout duties.

3.5 Impaired colour vision presents a risk to engineers who may be required to
distinguish the colours of electrical wiring in order to make proper electrical
connections. As such, it presents a risk depending on the degree of impairment that
may affect a person‟s ability to perform his duties. However, engineers and ratings
may provide evidence from a relevant employer that, within the last two years, impaired
colour vision, if present, has not been found to affect their work.
3.6 When testing colour vision, coloured lenses should not be worn by the seafarer.

     Note: The wearing of contact lenses or spectacles with chromagen lenses with red
     filters will increase the contrast of greens, yellows & browns, thus enabling a
     colour deficient seafarer to pass the Ishihara test. Unfortunately, these lenses are
     not sufficient to enable safe watchkeeping duties at sea..

3.7 Information regarding colour vision impairment must be provided on the medical
certificate to assist the employer to make an appropriate decision regarding engagement
or continued employment.

     Note: Guidance on appropriate screening for colour vision is contained in
     Appendix 5.




18                                                                        Order No 22 of 1999
 MEDICAL FITNESS                                                APPENDIX 2                                                                               PART 9
 OF SEAFARERS                                                    (continued)                                                                              Issue 5


                                                               Table 1: Visual standards
                                                               Distant vision                   Near                                              Visual


                                                               Better     Other      Both                 vision a              Colour vision       fields
                                                                eye        eye a     eyes




                                                               not less   not less   not less
    Deck department                                             than       than       than




    1. Seafarers required to undertake watchkeeping duties:



          -    with or without glasses or contact lenses c       6/6       6/9        6/6        N8 for charts, weather          Normal(b)         Normal
                                                                                                 maps and N12 for other                            visual
          -    unaided vision                                   6/12      6/24       6/12         reading tasks with or                    )        fields
                                                                                                   without visual aids
                                                                                                                                Normal(b

    2. Seafarers required to operate lifting plant eg ships‟
         cranes, hoists:


          -     with or without glasses or contact lenses c      6/9      6/12        6/9                   N12              Distinguish red(d)    Normal
                                                                                                       with or without                             visual
          -     unaided vision                                  6/60      6/60       6/60                visual aids         Distinguish red(d)     fields


    3. Seafarers not required to undertake duties in 1 or 2:    6/18      6/60       6/18       N12 with or without visual         N/A            Sufficient
         (aided vision if necessary)                                                                      aids                                     visual
                                                                                                                                                    fields




Order No. 22 of 1999                                                                                                                                19
PART 9                                                                       APPENDIX 2                                                                      MEDICAL FITNESS
Issue 5                                                                       (continued)                                                                      OF SEAFARERS


                                                                    Table 1: Visual standards (continued)

                                                                                        Distant vision                   Near                                           Visual
                                                                             Better        Other       Both              vision a                Colour vision          fields
                                                                              eye           eye a      eyes

                                                                             not less      not less   not less
     Other departments                                                        than          than       than


     Engine room (includes electrician):                                      6/12          6/60      6/12                                                            Sufficient
                                                                                                                 N12 to read instruments,
     (aided vision if necessary)                                                                                                                 See Annex 2           visual
                                                                                                                 gauges on control panels
                                                                                                                                                                        fields

     Catering department: aided vision allowed if necessary                   6/12          6/60      6/12       N12 to read instructions                             Sufficient
                                                                                                                 and catering equipment          Not required          visual
                                                                                                                     control panels                                     fields

     Note:   (a)   For seafarers who have proof of a satisfactory record of service, monocular vision is permitted excepting those seafarers who have to operate lifting
                   equipment such as cranes.

             (b)   See Appendix 5

             (c)   In all cases, where visual aids (spectacles or contact lenses) are required for the efficient performance of duties, a spare pair must be carried when
                   seafaring. When different visual aids are used for distance and near vision a spare pair of each must be carried.

             (d)   It is sufficient if the applicant can distinguish red from other colours. See Appendix 5.




20                                                                                                                                                 Order No. 22 of 1999
MEDICAL FITNESS                        APPENDIX 2                                   PART 9
OF SEAFARERS                            (continued)                                  Issue 5



3.8 Any eye disease or defect which affects vision needs to be corrected.
3.9 A history of glaucoma or uveitis needs ophthalmological assessment.
3.10 The vision standards listed in Table 1 are those that are internationally accepted
as appropriate.
                       4. Hearing, ear, nose and throat conditions
Hearing standard
4.1 Hearing is required for communication by radio, by telephone or person to person
and therefore the critical frequencies are in the speech range 500 to 2,000 Hz. Hearing
loss should be checked throughout the range of 500 to 3,000 Hz using a pure tone audio
meter.
4.2 The speech must be reasonably clear and free of stutter and hesitation sufficient to
use radios and communicate on deck. Those using cranes must be able to hear whistle
signals where these are used.
    Table 2: Minimum Standards of Hearing for Deck and Engine Departments
                                                  Frequency Hz

                              500    1,000     2,000       3,000   4,000    6,000

         dB loss in better    30      30        30          30      60       60
         ear with aids

         dB loss in better    40      40        40          40       -        -
         ear without aids

4.3 If hearing loss is 40dB or more at the frequencies specified in Table 2, ability to
use a radio will need to be demonstrated. In this circumstance the applicant must pass a
conversation test.

The conduct of the conversation test
4.4 The following is a recommended procedure for conduct of a conversation test.
4.5 The test should be conducted in a quiet room with a stable background noise level.
Hearing aids should be worn if normally used at work or if retesting following their
fitting.




Order No. 22 of 1999                                                                    21
PART 9                                 APPENDIX 2                        MEDICAL FITNESS
Issue 5                                 (continued)                        OF SEAFARERS


4.6 The examiner should face the subject and address him/her from a distance of 3
metres for normal speech.

4.7 The subject‟s eyes should be closed or covered to prevent lip reading.

4.8 A normal conversational vocal volume should be used.

4.9 The test material should be a mixture of alphabetical letters and numerals in any
order, not to exceed a total of three in any one phrase, eg 6Y3, 2N4, S5G, 7BL.

4.10 Ten combinations should be used, each preceded by the carrier phrase
“PLEASE SAY”.

4.11 The subject should repeat what was thought to be heard. If uncertain guessing is
encouraged.

4.12 Six or more combinations should be repeated without error to be considered
satisfactory.

4.13 Applicants who do not pass this test should be referred for further assessment of
functional hearing and speech discrimination by an audiologist.

4.14 A functional hearing loss sufficient to interfere with communication or to impede
safety (eg hearing audible warning devices) presents a high risk.

Other ear, nose and throat conditions

4.15 Acute infections require treatment. Although chronic middle ear disease presents
a high risk, recurrent or chronic sinus infection presents less of a risk if the Medical
Inspector is satisfied that the seafarer can manage the condition with appropriate
medication at sea.

4.16 Vestibular malfunction can occur suddenly and with sufficient severity to make
safe operations of vessels and cranes impossible. It may be accompanied by nystagmus
which compounds the disability. Meniere‟s disease therefore presents a high risk.

4.17 Hay fever which responds to therapy (without side effects) presents a lower level
of risk.

4.18 Frequently recurring tonsillitis presents a high risk until corrected.




22                                                                       Order No. 22 of 1999
MEDICAL FITNESS                       APPENDIX 2                                  PART 9
OF SEAFARERS                           (continued)                                 Issue 5


                             5 Cardiovascular system
5.1 Cardiovascular conditions can cause sudden loss of consciousness putting others at
risk or interfere with exercise tolerance as in climbing or working in confined spaces.
Some cardiovascular conditions, if they become acute, can require immediate
emergency medical care or medical evacuation, neither of which may be available,
particularly in remote locations and/or in bad weather.

5.2 Careful assessment is required to ensure applicants are free of any cardiovascular
condition which puts themselves or others at risk. Seafarers 55 years and over, or those
with a history of cardiovascular disease, will require a resting ECG. A stress ECG may
be performed if clinically indicated.

Ischaemic heart disease

5.3 Current angina presents a high risk. Any occurrence within the previous 3 months
of confirmed myocardial infarction, coronary artery bypass grafting, coronary
angioplasty or stent presents a high risk.

5.4 A lower risk is presented if the seafarer has had no symptoms of coronary artery
disease for more than 3 months and there is good control of risk factors with no
medication for angina control necessary. Review should be by a cardiologist using
results of tests, e.g. angiogram, stress ECG. Any doubt about medical fitness should be
referred to an independent medical panel.

5.5 If the review finds that 3 months or more has elapsed since the last symptom
incident, there are no signs of ischaemia on the exercise ECG (less than 2mm ST
segment depression) and/or coronary angiography shows a lumen reduction of less than
70% in a major coronary branch and less than 50% in the left main coronary artery, and
the ejection fraction is 50% or more, the seafarer could be declared fit for duty at sea
but with annual or more frequent cardiological review highly recommended.

Arrhythmia/pacemaker

5.6 A history of recurrent or persistent arrhythmia which may result in syncope or
incapacitating symptoms presents a high risk.

5.7 A seafarer who has had surgery (eg for Wolf-Parkinson White syndrome), or
successful treatment by medication for at least 3 months, may be declared fit subject to
annual cardiological review.




Order No. 22 of 1999                                                                  23
PART 9                                APPENDIX 2                       MEDICAL FITNESS
Issue 5                                (continued)                       OF SEAFARERS


5.8 If the seafarer has had a pacemaker implanted and the Medical Inspector has taken
into account the nature of the person‟s underlying disease and is satisfied that the
pacemaker function has been appropriately tested, the seafarer may be declared fit
subject to 6-monthly testing at a pacemaker clinic and cardiological review. Note that
some ships have strong electro-magnetic fields near communications equipment and
aerials which may affect pacemaker function.

Valvular heart disease

5.9 A history or evidence of valve disease, associated with symptoms or a history of,
embolism, arrhythmia, cardiac enlargement (on chest X-ray), abnormal ECG, or high
blood pressure presents a high risk.

5.10 Taking anticoagulants is acceptable if the dosage has been stable over time and
monitoring of the blood is compatible with swings.

5.11 A seafarer may be considered fit for duty at sea if cardiological assessment shows
mild or treated valvular disease of no haemodynamic significance, and it is not
associated with any symptoms, and any monitoring of the condition can be done at
frequencies compatible with swings.

5.12 Equivocal cases should be referred to an independent medical panel.

Cardiomyopathy

5.13 Established cardiomyopathy presents a high risk.

5.14 A heart or heart/lung transplant presents a high risk.

Aneurysms

5.15 A history of an aortic aneurysm, thoracic or abdominal, either before or after
surgery presents a high risk.

Hypertension

5.16 Blood pressure (taken whilst seated) of 160/100 or greater (treated or untreated)
presents a high risk.

5.17 End organ damage (cardiac, cerebral, retinal or renal) which would impair safe
operation of ships, cranes or small craft presents a high risk.




24                                                                    Order No. 22 of 1999
MEDICAL FITNESS                         APPENDIX 2                                 PART 9
OF SEAFARERS                             (continued)                                Issue 5


5.18 Any medical condition that requires the use of medication which can result in
marked hypotension or impaired alertness which would cause distraction of attention
whilst operating a ship, crane, or small craft presents a high risk.

5.19 A certificate of medical fitness for duty to sea may be issued, subject to annual
review:
    -    if the seafarer is treated with anti-hypertensive drug therapy and effective
         control of hypertension is achieved (ideal blood pressure less than or equal to
         140/90 but no greater than 150/95) without appreciable side effects over a four
         week follow-up period;
    -    if there is no evidence of target organ damage, associated ischaemic or other
         forms of heart disease; and
    -    if other causative risk factors have been treated.

Congenital heart disease

5.20 Congenital heart disease (eg atrial septal defect, small ventricular septal defect)
without symptoms and with no haemodynamic significance may be acceptable.

Peripheral circulation

5.21 Current or recent history of deep vein thrombosis with or without embolisation
presents a high risk. Varicose veins associated with ulcers or other complications
presents a high risk.

5.22 Intermittent claudication presents a high risk.

Pulmonary circulation

5.23 A history of more than one pulmonary embolus presents a high risk. A single
episode requires careful assessment of the underlying cause and risk of recurrence.

                                 6 Respiratory system
6.1 Disorders of the respiratory system should be considered in the context of the risk
of an acute exacerbation requiring emergency medical treatment (eg asthma,
pneumothorax) or symptomatic airway disease sufficient to reduce capacity for physical
work or ability to wear a respirator. Ability to wear a respirator may be required in
ships carrying cargoes of grain or cement, or oil tankers and ships carrying chemical
cargoes.




Order No. 22 of 1999                                                                     25
PART 9                                 APPENDIX 2                       MEDICAL FITNESS
Issue 5                                 (continued)                       OF SEAFARERS


Pneumothorax

6.2 A history of recurrent pneumothorax presents a high risk. A single episode without
recurrence for a year, or after successful surgical correction is acceptable.

Asthma

6.3 Asthma, chronic obstructive or restrictive airways disease and emphysema affect
the ability of an individual to use self-contained breathing apparatus, and to wear
respirators. Persons with asthma or allergy may find working on grain ships affects
their respiratory function.

6.4 Asthma requiring oral corticosteroids and/or frequent medication presents a high
risk.

6.5 A history of childhood asthma subsequently resolved in adolescence is acceptable.

6.6 Well-controlled asthma on inhaled corticosteroids and intermittent need of
bronchodilators may be acceptable. A report from the seafarer‟s treating physician may
be required.

     Note: There are persons with mild asthma whose symptoms are precipitated by
     obvious causes such as a respiratory tract infection and there are persons who
     can suddenly develop life-threatening asthma requiring hospitalisation. The
     latter have an asthma which is often more difficult to control and an obvious
     precipitating factor may not be identified for each asthma attack. This sub-group
     of asthmatics presents a high risk.

Reduced lung function

6.7 Severe respiratory disorders can interfere with the safe operation of ships and
cranes and confined space work through inadequate oxygen and/or increased carbon
dioxide to the brain and heart, leading to poor judgement, agitation or drowsiness,
reduced concentration and cardiac effects such as right heart failure or arrhythmia.

6.8 For jobs requiring the use of a respirator because of entry into confined spaces or
for work on grain and cement ships, an FEV1 below 65%, FVC below 70% and/or
FEV1/FVC less than 70% are grounds for concern. A practical respirator assessment
should be requested if wearing respirators is an essential task requirement.

6.9 In some cases of reduced lung function, individuals who get dyspnoea on exertion
may find climbing ladders on ships too difficult. A person who is unable to keep pace



26                                                                     Order No. 22 of 1999
MEDICAL FITNESS                        APPENDIX 2                                   PART 9
OF SEAFARERS                            (continued)                                  Issue 5


with people of the same age and body build when walking on level ground or who has
dyspnoea on one flight of stairs will have difficulty climbing stairs and ladders,
climbing over plant and equipment, and walking reasonable distances on board ship. If
in doubt, a practical test should be requested.

Tuberculosis

6.10 Untreated tuberculosis or other serious infection presents a high risk. Where the
applicant has suffered tuberculosis or other serious lung infection, a letter from the
treating physician should be obtained to certify that the seafarer is no longer infectious.

Chest X-rays

6.11 A chest X-ray is required at entry i.e. for pre-sea medicals and may be required
where there is a history of tuberculosis, or pneumothorax and/or when clinically
indicated. There is no requirement for routine chest X-rays.

                             7 Gastrointestinal system
Teeth and gums

7.1 Seafarers must be dentally fit as, other than temporary pain relief, there is no dental
treatment aboard ship. Dental abscesses or severe gingivitis presents a high risk.
Seafarers with impacted wisdom teeth may need dental review.

Peptic ulcer

7.2 Acute peptic ulceration presents a high risk. However treated peptic ulceration is
acceptable provided that the Medical Inspector is satisfied that the risk of recurrence,
especially haemorrhage, is minimal. A letter from the treating physician, together with
endoscopy report, may be required.

Liver and pancreas

7.3 A history of recurrent or chronic pancreatitis presents a high risk. Serious or
progressive liver disease such as cirrhosis with complications of oesophageal varices
presents a high risk.

Gall bladder disease

7.4 A person with a history of cholelithiasis and/or cholangitis should be carefully
evaluated for the risk of recurrence before being accepted as fit for duty at sea.




Order No. 22 of 1999                                                                    27
PART 9                                APPENDIX 2                        MEDICAL FITNESS
Issue 5                                (continued)                        OF SEAFARERS


Hernia
7.5 A hernia presents a high risk unless surgically corrected, with the exception that an
applicant who has a small inguinal hernia where there is no risk of strangulation and
where there is surgical opinion to state that there is no clinical indication for surgery
may be determined as fit for lifting tasks.
7.6 A rectus divarification or large umbilical hernia should be surgically corrected
before applicants can be accepted as fit for lifting tasks.
7.7 A diaphragmatic hernia without disabling reflux oesophagitis or other symptoms is
acceptable.

Colostomies

7.8 A person with an uncomplicated stoma is acceptable provided that the underlying
cause is compatible with work offshore and there are adequate facilities for changing
colostomy bags on board ship.

Enteric diseases
7.9 Catering crew should be free of infectious enteric diseases, including hepatitis A.
A faecal specimen will be required. A positive test should be discussed with an
infectious diseases specialist.
7.10 Catering crew and those exposed to sewage (eg engineers maintaining sewage
treatment plants) require hepatitis A immunisation on employment.

                                  8 Genitourinary
8.1 Any person who has haematuria and/or protein on urinalysis should be carefully
assessed to exclude any condition which may suddenly worsen and require urgent
medical attention, eg renal calculi.
8.2 A history of renal calculi requires advice on fluid intake in hot weather. The
presence of untreated renal calculi presents a high risk.
8.3 Urinary incontinence presents a high risk.
8.4 A large untreated hydrocele presents a high risk. A small symptomless hydrocele
is acceptable.




28                                                                     Order No. 22 of 1999
MEDICAL FITNESS                          APPENDIX 2                                  PART 9
OF SEAFARERS                              (continued)                                 Issue 5


8.5 Prostatism, due to prostatic hypertrophy sufficient to cause urinary symptoms such
as frequency or poor stream, presents a high risk until treated due to the risk of acute
urinary retention.

8.6 Menstrual dysfunction which can lead to incapacitating pain or haemorrhage, eg
severe endometriosis or menorrhagia presents a high risk.

8.7 Pregnancy affects fitness for duties at sea because of:
        the risk of hypotension, especially in hot weather
        the risk of falls due to the change in the centre of gravity
        difficulty climbing because of increased abdominal girth and additional
         cardiovascular load
        nausea from „morning sickness‟ which may be exacerbated by sea conditions.

8.8 Antenatal and obstetric care is not available at sea, and a miscarriage could be life-
threatening. Pregnancy therefore presents a high risk except for a woman with a
previous uncomplicated pregnancy who is less than 28 weeks into her pregnancy and
who works on short coastal runs only. A report from the treating obstetrician should be
obtained.

                                 9 Neurological system
9.1 Sudden loss of consciousness or loss of control of limbs or balance impairs the
ability to control a ship, ship‟s small craft or a crane, and to work at heights or alone.

Epilepsy

9.2 Epilepsy can be affected by fatigue. Shift work can therefore exacerbate the
condition if a person fails to get adequate sleep. Confirmed or current epilepsy, with a
fit within the previous 2 years, presents a high risk. For seafarers with well-controlled
epilepsy, evidence of treatment and control of epilepsy (eg letter from treating
specialist) must be provided for the condition to be acceptable.

   Note: Although only about one-third of patients with a first unprovoked seizure
   will have further seizures within 5 years, about 75% of those with two or three
   unprovoked seizures have further seizures within 4 years.

9.3 A past history of convulsions after the age of 5 years, with a seizure-free period of
at least two years, and not requiring medication, should be carefully assessed.



Order No. 22 of 1999                                                                     29
PART 9                                APPENDIX 2                       MEDICAL FITNESS
Issue 5                                (continued)                       OF SEAFARERS


9.4 A past, single seizure or cluster of seizures due to exceptional and non-repeatable
circumstances (eg head injury with complete recovery) may be acceptable.

Migraine

9.5 Acute incapacitating attacks of migraine which may be accompanied by
neurological signs such as hemiparesis and visual defects presents a high risk.

9.6 An established history of migraine which does not interfere with capacity to work
safely is acceptable.

Stroke

9.7 A history of cerebrovascular accident generally presents a high risk. However
depending on the degree of recovery from the stroke, and provided that problem
solving skills and judgement have not been affected, a person may be considered fit for
duty at sea after neuropsychometric evaluation and a report from the treating
neurologist / rehabilitation physician indicating that a recurrence is unlikely and that
there is no residual disability.

Transient ischaemic attacks (TIAs)

9.8 If a cardiac cause for such episodes is found and treated, then any restriction
should be based on the prognosis of that condition, and the likelihood of recurrences.

9.9 Where the aetiology of the attacks has been identified, the underlying cause
removed, and a six-month period free of attacks has elapsed, the condition may be
acceptable.

9.10 In such cases as outlined above, a review by a cardiologist/neurologist will be
required.

Neuromuscular Disorders including Multiple Sclerosis, Parkinsonism

9.11 Parkinsonism, multiple sclerosis, or other neuromuscular disorders would
preclude being in control of a ship, operating cranes or other equipment and, where the
disability is any more than minor muscular weakness, can affect climbing ability on
ship‟s rope ladders and steel rung ladders. Because of the progressive nature of most
forms of neuromuscular disorder, these conditions generally present a high risk.

9.12 Drug induced Parkinsonism may disappear on cessation of the treatment.
Should this occur, and the underlying case for which the drugs were administered not



30                                                                     Order No. 22 of 1999
MEDICAL FITNESS                          APPENDIX 2                                   PART 9
OF SEAFARERS                              (continued)                                  Issue 5


be a cause for exclusion in its own right, then the applicant may be considered fit for
duty at sea.

                                10 Psychiatric conditions
10.1 Affective disorders affect judgement, attention and motor activity and the Medical
Inspector should consider this in relation to any jobs with responsibility for the safe
operation of ships, cranes and equipment, including emergency procedures. The
Medical Inspector should also be aware that ship-board life involves periods of months
away from home, family and other support mechanisms, including psychiatric support.

10.2 An acute episode of mental illness (eg schizophrenia, manic depressive or other
psychoses) or a chronic mental illness manifested by symptoms which indicate there is
the likelihood of relapse such that the sufferer may cause harm to herself or himself or
others, the ship or its cargo, presents a high risk .

10.3 A mental disorder requiring psychotropic drug therapy presents a high risk if the
side-effects of such medication affect alertness, co-ordination, cause drowsiness or
postural hypotension.

10.4 A present or past mental disorder affecting judgement or psychomotor ability
presents a high risk.

10.5 Where the mental illness has been controlled and a report obtained from the
treating psychiatrist to the effect that a recurrence is unlikely, the person may be
considered fit, subject to regular review.

10.6 In all cases, where there is doubt about fitness, a psychiatric consultation should
be sought.

                       11 Prescribed medication, drugs and alcohol
11.1 Some prescription, over-the-counter, or illegal substances have the capability of
altering vision, perception, judgement, attention span, motor function and other
characteristics important in the safe operation of ships, cranes, lathes, and powered
tools.

Prescribed and over-the-counter drugs

11.2 The main issues with these drugs in relation to fitness for duty at sea are:
        can side-effects place the safety of the person or the safety of others at risk?



Order No. 22 of 1999                                                                        31
PART 9                                   APPENDIX 2                       MEDICAL FITNESS
Issue 5                                   (continued)                       OF SEAFARERS


         does the medication require monitoring?
         is the underlying disease, for which the medication has been prescribed,
          compatible with working at sea?
         what is the likely effect of several missed doses if seasickness precludes taking
          or absorbing medication?

11.3 If the medication is for short term administration, the person may be considered as
temporarily unfit and re-examined.

11.4 Long term administration of some medications may lead to tolerance of sedative
side effects eg antihistamines. Once this has stabilised, the taking of medications per se
is not a bar to operating plant and equipment. The Medical Inspector should be
satisfied that the person does not suffer sedative side effects and is aware of the
potentiation effects of alcohol.

11.5 The short or long term use of prescribed psychoactive drugs requires, at a
minimum, strong warnings about the potentiation by alcohol. It is desirable that
alternative therapy, with non-psychoactive drugs if possible, is undertaken. Each case
will need to be assessed individually and discussed with the person‟s treating
practitioner. More frequent reassessment will be required.

11.6 Persons using anti-histamines should use those with the least sedative side-effects
eg astemizole (Hismanal).

11.7 Cytotoxic agents, insulin, immunosuppressants, oral corticosteroids present a high
risk.

11.8 Major tranquillisers, narcotics and hypnotics present a high risk. A previous
history of such treatment will require further consideration.

11.9 Prescribed medication must be listed on the health assessment report form. The
applicant must be warned that he or she must have adequate medication to last a swing.




32                                                                        Order No. 22 of 1999
MEDICAL FITNESS                             APPENDIX 2                                  PART 9
OF SEAFARERS                                 (continued)                                 Issue 5


Table 3: Classes of drugs with potential to affect an individual‟s skills to operate
                ships, boats, plant and equipment, including cranes, are:
         Class of drug                                     Examples

         sedative, hypnotic or anti-anxiety agents         barbiturates
                                                           benzodiazepines

         analgesics                                        codeine
                                                           narcotics
                                                           propoxyphene

         ophthalmic agents (topical)                       most agents for treating
                                                           glaucoma

         anti-allergy agents                               antihistamines

         bronchodilators and asthma medications            salbutamol,
                                                           beclomethason
                                                           diproprionate,
                                                           sodium cromaglycate
                                                           budesonide

         antibiotics                                       minocycline

         antipsychotic or antidepressant agents            tricyclic anti-depressants
                                                           haloperidol
                                                           phenothiazines

         anticonvulsants                                   sodium valproate
                                                           phenytoin

         anticoagulants                                    aspirin
                                                           coumadin

         antihypertensives                                 clonidine
                                                           methyldopa
                                                           reserpine

         anti-motion sickness agents                       antihistamines


         unprescribed substances                           alcohol
                                                           amphetamines
                                                           cocaine
                                                           marijuana




Order No. 22 of 1999                                                                        33
PART 9                                 APPENDIX 2                        MEDICAL FITNESS
Issue 5                                 (continued)                        OF SEAFARERS


Illegal drugs

11.10 Illegal drugs such as opiates, cannabis and amphetamines may reduce a person‟s
ability to safely operate ships, cranes and machinery. Drug screening is not required
for a Certificate of Medical Fitness, although individual employers may initiate drug
and alcohol screening as part of company policy eg in the offshore oil industry. Such
policies are beyond the scope of these guidelines and further information, if required,
should be sought from the Australasian Faculty of Occupational Medicine and the
Centre for Education and Information on Drugs and Alcohol (CEIDA).

11.11 Any use of illegal drugs presents a high risk.

Alcohol

11.12 Alcohol is implicated as a significant factor in work-related accidents. It is a
statutory requirement that all persons, whilst on duty on a commercial vessel, have
essentially a zero blood alcohol level.

11.13 Chronic high alcohol intake (60g per day) impairs cognitive function such as the
processing and handling of sensory information and reduces the speed and accuracy of
response to psychomotor tasks. This may not become apparent until the person is in an
emergency situation.

11.14 A person with a clear history and clinical evidence of chronic alcohol abuse,
where there is evidence of end organ damage such as organic brain damage or
hepatomegaly, presents a high risk.

11.15 A seafarer who has been diagnosed as suffering from alcoholism should not be
considered as fit for duties at sea until a rehabilitation program has been completed and
the Medical Inspector is satisfied that the seafarer is fit to return to service on a ship.


     Note: The Seafarer’s Assistance Service provides an employees’ assistance
     program for seafarers with drug related or other problems. Counselling services
     available include drug and alcohol rehabilitation services.


                                 12 Musculoskeletal
12.1 Normal mobility, agility and strength in the spine and all limbs are important for
tasks involving climbing, lifting and confined space work.




34                                                                       Order No. 22 of 1999
MEDICAL FITNESS                         APPENDIX 2                                     PART 9
OF SEAFARERS                             (continued)                                    Issue 5


12.2 Ships have steep stairs, rope ladders and vertical steel rung ladders which must be
climbed and hatches which must be got through.

12.3 Rough weather will increase the need for reasonable hip, knee and shoulder
strength, flexibility and agility in relation to climbing.

12.4 The majority of lifting tasks are 25 kg or below and much use is made of lifting
equipment (cranes and hoists, forklifts) both on ships and on shore. Lifting is harder to
control during emergency procedures, when moving chains on deck, or when lifting
and carrying in confined spaces.

12.5 The following conditions present a high risk:
        amputation or congenital loss of an upper limb or lower limb if this affects
         climbing
        amputation or congenital loss of a lower limb if this is required to operate a foot
         control
        peripheral neuropathy resulting in loss of sensation or proprioception in the
         extremities as this makes climbing hazardous
        uncorrected knee instability eg locking, giving way
        uncorrected shoulder dislocation/subluxation
        acute inflammation and pain in any joint which interferes with concentration or
         impairs the range of motion such that disembarking from a boat cannot be
         performed safely - the person may need to be re-examined at a later date.

12.6 The following conditions also present a high risk because they affect the ability to
undertake manual handling, climb and occasionally maintain awkward postures in
engine rooms and other confined spaces:
        reduced range of movement or pain when rotating the neck - unable to look
         behind and/or up when operating plant, including cranes and hoists
        low back pain which affects activities of daily living and/or results in an
         inability to shovel, climb, maintain sustained and/or repetitive awkward
         postures
        painful spinal or shoulder movements with or without limitation in range of
         strength.

12.7 The Medical Inspector should carefully assess a person with a lower limb
prosthesis (eg for a below-knee amputation). An agility test may be required to prove



Order No. 22 of 1999                                                                       35
PART 9                                  APPENDIX 2                       MEDICAL FITNESS
Issue 5                                  (continued)                       OF SEAFARERS


that rope ladders, steel rung ladders and ships stairs can be climbed, or alternatively
evidence of satisfactory work performance at sea.

12.8 A person with a significant loss of range of motion or some loss of muscle power
may also require an agility test.

12.9 Where there is any doubt about mobility, the Medical Inspector should ask for a
practical test by contacting the referring employer.

                    13 Diabetes and other endocrine disorders
Diabetes mellitus

13.1 The Medical Inspector should bear in mind the risk to safety if the applicant had a
hypoglycaemic attack or developed a ketacidotic coma. In particular, attention is
drawn to watch keeping duties as there may be periods when the Master or Mate is
alone on the bridge and responsible for the safety of the ship eg whilst the Integrated
Rating or Mate is doing a round of the ship.

     Note: Insulin dependent diabetes mellitus is more difficult to manage for a person
     on rotating shift work. There is also the problem of administering optimal
     emergency care at sea to a person in a coma who may require urgent intravenous
     therapy.

13.2 The following conditions present a high risk:
         insulin dependent diabetes mellitus (IDDM)
         poorly controlled non-insulin dependent diabetes with unsatisfactory
          glucometer readings and/or recurrent glycosuria.

     Note: The International Labour Office (ILO) and the World Health Organization
     (WHO) have produced Guidelines on conducting pre-sea and periodic medical
     fitness examinations of seafarers which preclude persons with IDDM serving at
     sea.

13.3 Seafarers or applicants with a demonstrated responsible attitude to self-
management of a diabetic condition and a report from their treating practitioner
confirming adequate control of diabetes, lack of complications (ulcers, retinopathy,
renal disease) and ability to work shift work without the risk of a hypoglycaemic attack,
may be accepted.



36                                                                      Order No. 22 of 1999
MEDICAL FITNESS                        APPENDIX 2                                   PART 9
OF SEAFARERS                            (continued)                                  Issue 5


13.4 If the person‟s diabetes is currently uncontrolled eg due to change in therapy, it
may be necessary to consider him or her as temporarily unfit and subject to re-
examination in, say, three months.

Thyroid disease

13.5 Fitness for duties at sea will depend on the degree of control of thyroid disease,
the absence of complications, especially cardiac, and the requirements for monitoring
medication.

Adrenal disease

13.6 Disorders affecting adrenocortical hormone production such as Cushing‟s
syndrome or Addison‟s disease present a high risk unless the underlying cause has been
treated and the individual‟s adrenal function is sufficient.

                                  14 Skin disorders
Infections

14.1 Contagious skin disease presents a high risk unless the disease has been treated
and is no longer contagious.

Dermatoses

14.2 Mild endogenous eczema is acceptable but the Medical Inspector should be
satisfied that the condition will not be aggravated by exposure to oils, detergents or
other substances at work to a degree sufficient to render the applicant unfit for duty at
sea.

14.3 Psoriasis, not associated with polyarthritis, is acceptable.

                              15 Haemopoietic disease
15.1 Routine blood tests are not required for assessing medical fitness unless clinically
indicated, for example there are clinical signs of anaemia, lymphadenopathy,
haemarthroses.

15.2 Coagulation disorders such as Factor VIII deficiency present a high risk because
it will not usually be possible to treat an acute traumatic haemorrhage at sea with
replacement of clotting factors.

15.3 Leukaemias and myeloproliferative diseases present a high risk.


Order No. 22 of 1999                                                                    37
PART 9                                 APPENDIX 2                       MEDICAL FITNESS
Issue 5                                 (continued)                       OF SEAFARERS


15.4 Chronic lymphatic leukaemia if mild and asymptomatic may be acceptable.

                                16 Infectious diseases
16.1 Active infectious disease presents a high risk. Tuberculosis and contagious skin
diseases are mentioned in the relevant sections.

16.2 Catering staff must be free of enteric diseases, including hepatitis A. Faecal
specimens are required at each examination (see also gastrointestinal section).

16.3 HIV testing is not routinely required and should not be done unless there is a
clinical indication. Whilst a positive HIV test is not a bar to employment, evidence of
AIDS (Acquired Immunodeficiency Syndrome) presents a high risk. Of particular
concern are neurological or neuropsychiatric and other complications which would
compromise safety.

                                    17 Neoplasms
17.1 Neoplasms of any type have the potential to disqualify an applicant or seafarer
from duties at sea because of:
         acute symptoms, eg hemianopia with pituitary tumours
         complications eg pulmonary emboli
         side-effects of treatment/medication, eg immunosuppression, anaemia, nausea.

17.2 Frank malignant disease presents a high risk. Seafarers should be carefully
reassessed after a diagnosis of cancer is confirmed and treatment instituted. The natural
history and prognosis of the neoplasm should be taken into account. The progress and
likelihood of complications of the disease or its treatment must also be carefully
evaluated.




38                                                                     Order No. 22 of 1999
MEDICAL FITNESS                        APPENDIX 2                    PART 9
OF SEAFARERS                            (continued)                   Issue 5


                                                               ATTACHMENT

                                 Recommended forms




                          Medical Examination Request Form

                          Medical Examination Questionnaire

                          Medical Inspector's Report




Order No. 22 of 1999                                                     39
PART 9                                                   APPENDIX 2                                        MEDICAL FITNESS
Issue 5                                                   (continued)                                        OF SEAFARERS




                              Medical Examination Request Form
                                      (To be completed by the Employer)
            To:         Dr.         ……………………………………………………………..



                  Address:          …………………………………………………………….

                                    …………………………………………………………….

              Telephone:            …………………………………………………………….

                     Date:          ……………………………………………………………..

                                             pre-sea*
          Please carry out a                 periodic*              health assessment of
                                             other*

          ………………………………………………………………………………………….

          for the position of                ……………………………………………………………

          Yours sincerely




          Please keep all the Medical Examination Forms in your confidential files in accordance with normal medical
          practice and return a copy of the Certificate of Medical Fitness together with your account to:


                Name:           ……………………………………………………………………

             Position:          …………………………………………………………………….

             Address:           ……………………………………………………………………..

                                ………………………………………………………………………

          Phone:                                                      Fax:
          ……………………………….                                               …………………………………

                                               * delete where not applicable



40                                                                                                         Order No. 22 of 1999
MEDICAL FITNESS                                APPENDIX 2                                          PART 9
OF SEAFARERS                                    (continued)                                         Issue 5




  Medical Examination Request: Work environment
  To be read by Examining Doctor
  Work at sea may require physical effort within the limits set by applicable international health and
  safety legislation and awards. This may include exposure to:
        Noisy work environment                         Climbing ladders (rope and steel rung)
        Communicating by radio                         Working in confined spaces
        Handling solvents, oils, grease or             Close eye work
        paint                                           -     reading charts, diagrams, safety
        Manual work e.g. lifting, pulling,                    instructions, manuals
        reaching, shovelling                            -     using a computer
        Prolonged sitting/standing                     Colour vision to identify navigation lights,
        Hot environment/cold environment               coloured wires
        Working at heights up to 30 metres             Operating ships, small vessels, cranes,
        Working near machinery                         forklifts, hoists
        Climbing on vessels and ships small            Operating handtools and powered tools eg
        craft                                          rattlegun, airhammer
                                                       Work in areas remote from medical care
  If in your opinion the applicant is generally fit for employment please advise whether his/her
  employment should be restricted in relation to any of these activities by completing the
  Certificate of Medical Fitness.
  See also the relevant job task analyses which are in Attachment 2 to these Guidelines.
  Please note that the following tests will be required for each job group.
         Job           Audio-   Spiro-     Resting ECG        Chest x-Ray     Vision         Faecal
       Grouping        gram     metry                                        Screening      specimen

      All ships        needed   needed   55 years of age   Divers             needed       not needed
      crew                               and over
                                                           New entrants
                                          Stress ECG:
                                                           ie pre-sea
                                         if clinically
                                         indicated
      Catering         needed   needed   55 years of age   New entrants       needed        needed
      staff                              and over          ie pre-sea


      You will need the following equipment to conduct the medical examination:
           height measure                      audiometer
           weight scales                       Ishihara colour plates
           stethoscope                         Snellen‟s eye chart
           tendon hammer                       Times-Roman or Jaegar eye chart
           tuning fork                         sphygmomanometer
           urine testing sticks (albumin, glucose, blood etc)




Order No. 22 of 1999                                                                                    41
PART 9                                                                                       APPENDIX 2                                                                      MEDICAL FITNESS
Issue 5                                                                                       (continued)                                                                      OF SEAFARERS


                                               Medical Examination Questionnaire
Please complete this questionnaire prior to attendance, but leave blank the answer to any question you do not
understand. You must bring a suitable means of identification (passport, certificate of competency, driving licence)
with you to the examination


Name:
                      LAST NAME                                                                                        FIRST NAME(S)

Date of birth:                                                                                                 Male or female:

Home
address:

Name, address and phone
number of treating doctor:

Proof of identity                                                                                              Passport/Driving
(eg photo licence,                                                                                             Licence No:
passport):


Type of ship (container,
tanker, passenger, fishing):


Trade area (eg coastal,
tropical, worldwide):



The following should be signed in the presence of the examining medical officer.

Declaration
I hereby declare that my personal statements are true and correct to the best of my knowledge.


......................................................................................................                ..............................................................................
                                      Applicant’s signature                                                                                                Date

Authority to divulge medical information
If, as a result of this or subsequent examinations for the purposes of assessing my medical fitness for duty at sea, the examining
medical officer requires relevant medical details from my treating medical advisor(s), permission is hereby granted to obtain
information from:
Dr       , ...................................................      Dr        , .................................................     Dr

......................................................................................................                ..............................................................................
                                      Applicant’s signature                                                                                                Date


Privacy Note. Please read carefully for information and guidance.
The information contained on this form and its associated documents will only be used for the purposes of assessing your medical
fitness for duty at sea and for AMSA audit purposes. This information will only be exchanged between your examining medical
officer and your treating medical practitioner and/or any medical panel convened to assess your fitness for duty at sea. If you do not
meet the medical fitness standard for duty at sea, you and your employer will be advised of this on the Certificate of Medical Fitness.
A copy of this questionnaire is to be forwarded by the Medical Inspector to AMSA after the examination is completed. The Medical
Inspector may retain a copy of this questionnaire for record purposes.




42                                                                                                                                                                          Order No. 22 of 1999
MEDICAL FITNESS                                           APPENDIX 2                                                      PART 9
OF SEAFARERS                                               (continued)                                                     Issue 5


PERSONAL HISTORY
All questions must be answered
Have you now or have you previously had any of the following conditions? Circle „YES‟ or „NO‟ in space provided.

                                                                                                         MEDICAL INSPECTOR‟S
                                                                                                        COMMENTS required on any
                                                                                                           affirmative answer
1.

(a)   Mental or nervous condition       Yes/No   (f)   Attack of unconsciousness or
                                                       weakness                                Yes/No
(b    Anxiety state                     Yes/No   (g)   Migraine                                Yes/No
)
(c)   Epillepsy or fits                 Yes/No   (h)   Disturbance or sensation or muscular
                                                       activity                                Yes/No
(d    Persistent headaches              Yes/No   (i)   Poliomyelitis or other paralysis        Yes/No
)
(e)   Dizziness or turns                Yes/No

2.
(a)   High blood pressure               Yes/No   (g)   Disease of the heart of blood vessels   Yes/No
(b    Coronary artery disease           Yes/No   (h)   Anaemia or any other disease of the
)                                                      blood                                   Yes/No
(c)   Operation on the heart            Yes/No   (i)   Abnormal bleeding                       Yes/No
(d    Pains in the chest                Yes/No   (j)   Swelling of the ankles                  Yes/No
)
(e)   Palpitations                      Yes/No   (k)   Varicose veins                          Yes/No
(f)   Rheumatic fever                   Yes/No

3.
(a)   Indigestion or dyspepsia          Yes/No   (f)   Haemorrhoids (piles)                    Yes/No
(b    Gallbladder disease               Yes/No   (g)   Hernia (rupture)                        Yes/No
)
(c)   Disease of the liver (including            (h)   Appendicitis                            Yes/No
      jaundice hepatitis)               Yes/No
(d    Disease or ulcer of the stomach            (i)   Recurrent abdominal pain                Yes/No
)     or duodenum                       Yes/No
(e)   Disease of the bowels             Yes/No   (j)   Recent change in weight                 Yes/No

4.
(a)   Asthma                            Yes/No   (e)   Persistent cough                        Yes/No
(b    Bronchitis or emphysema                    (f)   Persistent breathlessness
)                                       Yes/No                                                 Yes/No
(c)   Tuberculosis                      Yes/No   (g)   Collapsed lung                          Yes/No
(d    Other lung disease                Yes/No   (h)   Abnormal chest X-ray in the past        Yes/No
)
5.
(a)   Infection of bladder              Yes/No   (d)   Kidney disease or kidney stone          Yes/No
(b    Difficulty in passing urine       Yes/No   (e)   Sexually transmitted disease            Yes/No
)
(c)   Any abnormality of the urine      Yes/No




Order No. 22 of 1999                                                                                                          43
PART 9                                                           APPENDIX 2                                            MEDICAL FITNESS
Issue 5                                                           (continued)                                            OF SEAFARERS



.
                                                                                                                 MEDICAL INSPECTOR‟S
                                                                                                                 COMMENTS required on
                                                                                                                  any affirmative answer
6.

(a)   Lumbago, sciatica or other back                (e)      Joint injuries                            Yes/No
      trouble                            Yes/No
(b)   Any form of arthritis or stiff                 (f)      Injury of the neck or back                Yes/No
      joints                             Yes/No
(c)   Slipped discs or back or neck                  (g)      Repetitive Strain Injury, tennis elbow,
      pain                               Yes/No               tendonitis                                Yes/No
(d)   Broken bones                       Yes/No      (h)      Gout                                      Yes/No

7.
(a)   Discharge from ears or                         (c)      Deafness                                  Yes/No
      perforated eardrum                 Yes/No
(b)   Ringing in the ears or                         (d)      Nasal or sinus trouble                    Yes/No
      disturbances of balance            Yes/No
                                                     (e)      Persistent husky voice or frequent
                                                              sore throat                               Yes/No

8.
(a)   Any form of cancer                 Yes/No      (b)      Any lumps or other tumours                Yes/No

9.
(a)   Goitre or Thyroid disease          Yes/No      (c)      Any other endocrine disease               Yes/No
(b)   Diabetes                           Yes/No

10.
(a)   Skin eruption                      Yes/No      (b)      Dermatitis or eczema                      Yes/No

11.
(a)   Allergy conditions including                   (c)      Any reaction to serum, drug or
      hay fever                          Yes/No               medicine (including anaesthetic
                                                              agents) and vaccines                      Yes/No
(b)   Any abnormality of the immune
      system                             Yes/No

12.
(a)   Malaria, typhoid, amoebiasis, or               (b)      Any other tropical disease
      giardia                            Yes/No                                                         Yes/No

13.
(a)   Severe tooth or gum trouble                    (b)      Impacted wisdom teeth
                                         Yes/No                                                         Yes/No

14.
(a)   Any obstetric or gynaecological                (b)      are you pregnant?                         Yes/No
      problems                           Yes/No

15*
(a)   Any eye disorder                   Yes/No      (c)      Any condition requiring glasses or
                                                              contact lenses to be worn                 Yes/No
(b)   Any injury to eyes                 Yes/No

          * If you wear glasses, corneal or contact lenses, bring them with you to the examination.
                                 TINTED LENSES MUST NOT BE WORN




44                                                                                                                    Order No. 22 of 1999
MEDICAL FITNESS                                                                                APPENDIX 2                                        PART 9
OF SEAFARERS                                                                                    (continued)                                       Issue 5


Please give details of


                                                                                                                   MEDICAL INSPECTOR‟S COMMENTS
                                                                                                                     required on any affirmative answer
16.   Any complaint, illness or injury not mentioned on previous pages
……………………………………………………………………………………………………
……………………………………………………………………………………………………
…………………………………………………………………………………………………..

17.   Absences from work due to sickness or injury over past two years

…………………………………………………………………………………………………..
…………………………………………………………………………………………………..
…………………………………………………………………………………………………..

18.   All accidents, surgical treatment or operations

…………………………………………………………………………………………………..
…………………………………………………………………………………………………..
…………………………………………………………………………………………………..

19.   Are you in good health now?

…………………………………………………………………………………………………..

20.   Are you taking any medications at present?

…………………………………………………………………………………………………..
…………………………………………………………………………………………………..

21.   Are you allergic to any medications?

……………………………………………………………………………………………………

22.   When did you last receive medical, chiropractic, surgical or other treatment and for what
      condition?

…………………………………………………………………………………………………..
………………………………………………………………………………………………….

23.   Are you aware of ANY circumstances regarding your health which will interfere with the
      satisfactory discharge of the duties of your designated position/occupation?

………………………………………………………………………………………………..

24.   Have you ever had a Mantoux test for tuberculosis (TB)? Yes / No
      If yes, what was the result? ..........................................................................
      Have you had a BCG vaccination against tuberculosis? Yes / No.
      Have you been immunised against the following - what year?:

      polio:              Yes / No                                   hepatitis A: ...... Yes / No
      tetanus:            Yes / No                                   hepatitis B: ....... Yes / No
      diphtheria:         Yes / No                                   typhoid:Yes / No
      TB:                 Yes / No                     yellow fever: Yes / No
25.   Do you or have you ever smoked tobacco? Yes/No
      If yes:
      Do you currently smoke? Yes/No
      How much each day? .......................................................................................
      If no, how long ago did you stop smoking? ..................................................




Order No. 22 of 1999                                                                                                                                 45
PART 9                                                                                                     APPENDIX 2           MEDICAL FITNESS
Issue 5                                                                                                     (continued)           OF SEAFARERS



26.   Do you drink alcohol? Yes / No.
      If yes, how much and how often?

27.   Do you do any regular exercise? Yes / No.
      If yes, what sort and how often?
      .......................................................................................................................

28.   Have you ever been signed off as sick or repatriated from a slip? Yes / No.
      If yes, give details.
      .......................................................................................................................


29.   Have you ever been declared unfit for duty at sea? Yes / No.
      If yes, state when, for how long and for what reason.
      .......................................................................................................................


30.   Has your Certificate of Medical Fitness ever been restricted or revoked? Yes / No.
      If yes, give details.
      .......................................................................................................................



MEDICAL INSPECTOR TO NOTE HERE ANY SIGNIFICANT MEDICAL CONDITIONS
WHICH MAY BE A RISK FOR WORK AT SEA REMOTE FROM MEDICAL FACILITIES




46                                                                                                                              Order No. 22 of 1999
MEDICAL FITNESS                                                                             APPENDIX 2                                                                       PART 9
OF SEAFARERS                                                                                 (continued)                                                                      Issue 5




                                                                 Medical Inspector‟s Report
                                                                                                          MEDICAL INSPECTOR‟S COMMENTS
                                                                                                          REQUIRED ON ANY ABNORMALITY.
1.     GENERAL APPEARANCE of the applicant
(a)    physique
(b)    presence of deformities
(c)    mobility
(d)    obesity
(e)    any other comments

2.     HEIGHT / WEIGHT

(a)    Height (without shoes)       ..........................................................
                                    metres

       Weight                       ..........................................................     kg

                                               Weight in kg
(b)    Body Mass Index (BMI)        =                                       ……………………
                                             Height in m  2
3.     VISION
                                                                                                          (c)    Are the visual fields satisfactory?
(a)    Is there any visual defect of the eyes?         Yes / No
       The visual acuity of each eye should be tested with Snellen‟s Charts, and
       the results recorded:

                                           Visual acuity                                                                                        Visual fields to confrontation

                        Unaided                                              Aided                                                          Normal               Defective

              Right        Left         Binoc-           Right               Left                Binoc-            Right eye
               eye         eye           ular             eye                eye                  ular

Distant                                                                                                            Left eye


Near



(b)    Does the applicant suffer from some degree of colour blindness as                                  (d)      Ishihara test:      Pass / Further testing needed
       determined by Ishihara plates?
                                                                                                          (e)      List plates with errors:
Colour vision:                                                                                            (f)      Lantern test:                       Required / Not required.

           Not tested                                       Normal                                              Coloured wires test:
                                                                                                          (g)     in good lighting:        Pass / Fail / Not applicable.
           Doubtful                                         Defective                                     (h)     further testing on board ship:
Colour vision need not be tested if a test has been completed within the
previous 6 years. Date of last colour vision test if not tested at this examination
……………..

4.     MOUTH / TEETH
(a)    Is there any disease or abnormality of the mouth, throat or neck? Yes /
       No.
(b)    Are there any defects in teeth? Yes / No.
       Please give details.
(c)    Is there any disease of the nose or sinuses? Yes / No.

5.     SPEECH / HEARING / BALANCE
(a)    Is there any defect in speech?                   Yes / No
(b)    Is there any disease of the ears?                Yes / No
(c)    Is there any defect in hearing?                  Yes / No
(d)    Romberg‟s test normal?                           Normal / Abnormal
                                                                       …. / continued



Order No. 22 of 1999                                                                                                                                                              47
PART 9                                                                                               APPENDIX 2                                                        MEDICAL FITNESS
Issue 5                                                                                               (continued)                                                        OF SEAFARERS



5.     SPEECH / HEARING / BALANCE (continued)                                                                             Conversation Test at 3 metres

                       Pure tone and audiometry (threshold values in dB)                                                                               Speech

                   500            1,000           2,000            3,000        4,000             6,000                            Both ears
                   Hz              Hz              Hz               Hz           Hz                Hz                              together              /10

Right
ear                                                                                                                       Conversation test only required if hearing loss in the
Left                                                                                                                      better ear is more than 30dB at 500 to 2000 Hz
ear



6.     CARDIOVASCULAR

(a)    After examination are you satisfied that the cardiovascular
       system is clinically within normal limits? If not, give reasons in
       full.

(b)    Pulse:       .......................    /min             Rhythm     ..................

(c)    Blood Pressure readings:
       Systolic          ....................................       Diastolic       ................................

(d)    If this reading is above 150/95 please take further readings after rest.
       Systolic          ....................................       Diastolic       ................................

(e)    Heart sounds / apex beat                       Normal / abnormal.

(f)    Is there any history or evidence of taking anti-hypertensive
       medication?

(g)    ECG Report (Attach report and tracing to page 11).                                                         ECG results:
       (Stress ECG required if clinically indicated. Baseline tracing
       only to be attached to this document.)

       Date of ECG: .............................................................................................

(h)    Does the applicant suffer from oedema or varicose veins? Yes / No.                                         Stress ECG result:
       If yes, state severity.                                                                                    (if clinically indicated)
(i)    Are carotid / peripheral pulses normal? Yes / No.

7.     RESPIRATORY

(a)    After examination are you satisfied with the clinical condition
       and efficiency of the respiratory system and chest? If not, give
       reasons.
       Trachea:           Midline / Abnormal                    Chest expansion:            5cm /
       abnormal
       Breath sounds                Normal / Abnormal

SPIROMETRY
                               Actual             Predicted                % Predicted

      FEV1

      FVC

      FEV1/FVC


       Spirometry            FEV1     < 65% requires further review
                             FVC      < 70% requires review
                             FEV1/FVC < 70% requires review

(b)    Chest X-ray report Normal / Abnormal                                     Date …………
       (Attach report to page 11.)
       (Chest X-rays are required for pre-sea medicals or if clinically
       indicated.)




48                                                                                                                                                                   Order No. 22 of 1999
MEDICAL FITNESS                                                         APPENDIX 2                                   PART 9
OF SEAFARERS                                                             (continued)                                  Issue 5



8.    GASTROINTESTINAL / RENAL

(a)   Is there any disease or abnormality of the abdominal organs? If yes,
      give particulars. Yes / No.

(b)   Is there any hernia present? Yes / No.

(c)   Is the liver enlarged? Yes / No.

(d)   Any renal bruits? Yes / No.

Urine dipstick results

                                                                                Glucose            Normal/Abnormal
                                                                                Protein            Normal/Abnormal
                                                                                Blood              Normal/Abnormal
                                                                                Other              Normal/Abnormal
Faecal cultures:           Normal / Abnormal
(catering staff only)
If abnormal, seek advice from infectious diseases specialist.
Hepatitis A, date of last vaccination:   /      /

Hepatitis A vaccine:       Given / Not given.

9.    NEUROLOGICAL / PSYCHIATRIC

(a)   Is there any evidence of organic disease of the brain, spinal cord, or
      nerves? Yes / No.

(b)   Is there any evidence of mental or nervous disorder including
      psychoses? Yes / No.

(c)   Is there any evidence suggestive of anxiety or panic disorder,
      personality disorder? Yes / No.


10.   MUSCULOSKELETAL

(a)   Does the applicant have normal use of the legs and arms?
       Yes / No.

(b)   Is gait normal? Yes / No.

(c)   Are the bones and joints free of any defects? Yes / No.

(d)   Are joint movements in normal range and pain free? Yes / No.

(e)   Any restriction or pain in movement of spine? Yes / No.


11.   SKIN / LYMPH NODES

(a)   Is there any skin disease, including solar keratoses, BCCs, eczema etc?
      Yes / No.

(b)   Are there any significant scars, ulcers, or enlarged lymph nodes?
       Yes / No.

(c)   Are there any skin grafts? Yes / No.

(d)   Are there any identifying marks on the skin? Yes / No.


                                             A copy of this document is to be forwarded to AMSA.




Order No. 22 of 1999                                                                                                     49
PART 9                                                   APPENDIX 2                                   MEDICAL FITNESS
Issue 5                                                   (continued)                                   OF SEAFARERS




                        ATTACH ALL TEST DOCUMENTS TO THIS PAGE

    CHEST X-RAY REPORT (for pre-sea medicals or if clinically indicated)

    ECG TRACING (for applicants aged 55 years or more and/or if clinically indicated)

    ECG REPORT (confirmed automatic machine report, or report by FRACGP or appropriate specialist)

    STRESS ECG (if clinically indicated)

    AUDIOGRAM REPORT

    STOOL PATHOLOGY REPORT (catering staff only)




50                                                                                                    Order No. 22 of 1999
PART 9                                                           MEDICAL FITNESS
Issue 5                                                            OF SEAFAIRER




                                           Appendix 3

                                       Job task analyses

   Table 1         Master/Mate/Pilot

   Table 2         Chief Engineer/Engineer/ Electrician/Fitter

   Table 3         Chief Integrated Rating/Integrated Ratings

   Table 4         Chief Cook/Cook/Steward

   Table 5         Catering Attendant and Steward




   Order No. 22 of 1999                                                            51
   PART 9                                                                                APPENDIX 3                                                              MEDICAL FITNESS
   Issue 5                                                                                (continued)                                                              OF SEAFARERS


                                                                                             Table 1: Master/Mate

      1. Vision                           2. Hearing/speech          3. Consciousness                   4. Physical                      5.Other

   read instructions                      give/take instructions      alert to changes in             climb narrow, steep stairs      work shiftwork (4 or 12 hour watches)
                                                                         machinery vibration eg          climb 3 metre rope ladders      occasional long hours of work (18+)
   read instruction manuals               use 2-way radios and
                                                                         engines                          at sea                          write reports (log)
                                            telephones
   read charts                                                                                          climb mast*
                                                                        alert to movements of                                            plan ship repairs*
                                           distinguish different
   read weather maps                                                    other vessels                   climb steel rungs/ladders       plan work schedules*
                                            auditory alarms
   distinguish red/white/green                                         alert to position of ship‟s     lift hatch covers*              away at sea for up to 6 months at a time*
    navigation lights                                                    ancillary craft                 fine motor skills to plot       fit through escape hatches*
                                                                                                         courses on charts, use
   distinguish coloured light alarms                                    interpret complex                                                work at high temperature, humidity and/or in
                                                                         information from digital,        keyboards on computer,
                                                                                                                                           extreme cold & in storms/cyclones etc
   observe aspect of other vessels                                      analogue and graphic             rotate knobs, pull levers,
                                                                                                          push buttons                    wear PPE–boots, overalls, hard hat, hearing
   read radar, GPS and other                                            computerised monitoring
                                                                                                                                           protection and occasionally respirators
    monitors (digital, analogue and                                      equipment eg radar, GPS,        assist with lifting, manual
                                                                         computerised charts,             labour eg lifting cylinders,    order deck stores*
    graphic)
                                                                         compass                          25 litre drums etc*             use computers to write reports, keep chart
   read computer screens                                                                                cleaning/maintenance of          catalogues*
                                                                        respond to alarms
   identify navigation lights from                                                                       the bridge (wheelhouse)*        check radio equipment, liferafts*
    beacons, buoys, lighthouse                                          alert to changes in weather     place tags for safety           inspect oil, other cargo, ballast and water tanks
    towers, other vessels                                               high level decision-making       checks*                          and other confined spaces*
   keep watch for obstacles to                                          in emergencies                  clean own cabin, shower ie      work with heavy seas on deck
    navigation                                                                                             bending, reaching,
                                                                        responsible for safety of                                        work in conditions involving heavy rolling and
                                                                                                           scrubbing, and wiping
   standing watch – night vision and                                    ship‟s crew and safety of                                         pitching of vessel
                                                                                                           (varies from ship to ship)*
    depth perception                                                     vessel
                                                                                                        Additional for supply vessels
                                                                        alert to movements and
                                                                                                         handle cargo on the back
                                                                         position of crew
                                                                                                          deck of a supply vessel*
                                                                                                         handle wires, chains and
                                                                                                          ropes during anchor
                                                                                                          handling*
                                                                                                         hook and unhook tows*
* These duties are not normally required of a pilot




 52                                                                                                                                                                Order No. 22 of 1999
         MEDICAL FITNESS                                                                APPENDIX 3                                                                             PART 9
         OF SEAFARERS                                                                   (continued)                                                                             Issue 5


                                                               Table 2: Chief Engineer/Engineer/Electrician/Fitter



     1. Vision                         2. Hearing/speech   3. Consciousness            4. Physical                                         5.Other
        read gauges, dials             communicate by        alert to alarms         lifting and carrying condenser coils, pipes,       work shiftwork (4 hour watches)
                                         2-way radio            (visual and              motors, pumps up to 35 kg – but can be             write reports (log)
        read instruction manuals,                                                       carried by two persons
                                                                auditory)                                                                   plan ship repairs
         drawings                       hear alarms and
                                                                                        lifting and carrying 25 kg containers of
                                         pager                 respond to                                                                  plan work schedules
        near vision for calipers                                                        chemicals
                                                                emergencies                                                                 away at sea for up to 6 months at
         and other instruments          give/take                                      use lathes, circular saws, hand tools, grinders
                                         instructions          alert to position of     & pedestal drill                                    a time
        near vision for identifying
                                                                ship‟s ancillary                                                            fit through escape hatches
         and using nuts, bolts,                                                         welding/oxy-cutting
                                                                craft
         screws, pins etc                                                               fine manual dexterity in placing nuts, bolts,      work at high temperature,
                                                               interpret complex        screws                                              humidity and/or in extreme cold
      ability to distinguish basic                                                                                                          & in storms/cyclones etc
                                                                information from
       colours to recognise                                                             turning valves, levers
       coloured alarms and
                                                                monitors and                                                                wear PPE–boots, overalls, hard
                                                                gauges on               pushing button controls                             hat, hearing protection and
       coloured wires
                                                                instrument control      climbing steep stairways, steel rung ladders,       occasionally respirators
                                                                panels in engine         rungs on masts and onto ship‟s crane               order engine room stores
                                                                room
                                                                                        standing and walking most of the shift             exposure to heat and fumes
                                                                                        working in awkward postures                        use computers to write reports,
                                                                                        working in confined spaces                          keep chart catalogues
                                                                                        working overhead                                   safe handling of chemicals
                                                                                        clean own cabin, shower ie bending,                check radio equipment, liferafts
                                                                                          reaching, scrubbing & wiping (varies from         inspect water tanks
                                                                                          ship to ship)
                                                                                                                                            work in conditions involving
                                                                                       Additional for supply vessels                         heavy rolling and pitching of
                                                                                        handle cargo on the back deck of a supply           vessel
                                                                                         vessel
                                                                                        handle wires, chains and ropes during anchor
                                                                                         handling
                                                                                        hook and unhook tows




53                                                                                                                                                                 Order No. 22 of 1999
     PART 9                                                                                   APPENDIX 3                                                              MEDICAL FITNESS
     Issue 5                                                                                   (continued)                                                              OF SEAFARERS


                                                                                  Table 3: Chief Integrated Rating/Integrated Rating

  1. Vision                 2. Hearing/speech                 3. Consciousness                4. Physical                                 5.Other
 read instructions,         give/take instructions           alert to movements of          manual dexterity to tie knots, splice      work at heights
  procedures                 hear whistles for crane/hoist        other persons, operating       rope, repair/use canvas tarpaulins,      work in high temperature, humidity and/or in
 read gauges, dials           movements                           machinery, ship‟s small        place slings, use pliers, spanners &       extreme cold, and in storms, cyclones etc
 read labels on             use 2-way radio                      craft and helicopter           other hand tools                         long work hours (up to 10-12 hours per day
  chemicals                  listen to machinery eg           monitor equipment              pulling knobs, levers, pushing buttons     away at sea for up to 6 months at a time
 distance vision when         crane, LARC                        including radar, digital        to operate crane, machinery,             fit through escape hatches
  operating small craft,     hear warning signals/alarms         and analogue read outs          incinerator                              shiftwork when on 4-hourly watch
                                                                                               reaching and working overhead              ship‟s fire and safety rounds – inspect all
  crane, hoist               use hands free headsets to          on gauges, GPS,
                                                                                               shovel ash from incinerator and lift
 see navigation lights        communicate by radio in            compass, and generally                                                     areas regularly
                                                                                                  bags of rubbish into incinerator
  of other vessels,            rough seas                         assist officer on watch
                                                                                               lift stores                                plan work schedules
  beacons, lighthouses                                                                         lifting from deck to overhead to load      wear personal protective equipment eg safety
  etc                                                                                             ship‟s small craft                         boots, earplugs or earmuffs, hard hat, gloves,
 distinguish red/green                                                                        climbing ship‟s rope ladders (3m) in         overalls, safety spectacles and occasionally
  coloured lights                                                                                 rough seas, and steel rung ladders on      respirators
 distinguish coloured                                                                            towers (up to 30m) whilst carrying       exposure to paints, thinners, oils, antifoul,
  light alarms                                                                                    ropes, light tool bag                      degreasers
 stand watch – night                                                                          lifting weights up to 50 kg (two           use fire-fighting hoses, extinguishers
  vision and depth                                                                                person lift)                             work in oil, other cargo, ballast and water
  perception                                                                                   lifting cables, boxes, batteries,            tanks and other confined spaces
 near vision for
                                                                                                  winches, hoists up to 40 kg              work in conditions involving heavy rolling
                                                                                               use powered tools, saws, drills,             and pitching of vessel
  identifying shackles,
                                                                                                  rattleguns, chisels, sledgehammers
  markings on slings,                                                                          mooring/unmooring vessels
  bolts, nuts, screws etc                                                                      use air/electric chain hoists – pulling
                                                                                                  on ropes, chain, and pressing buttons
                                                                                                  on handheld control box
                                                                                               carpentry/shipwright duties
                                                                                               standing for long periods (3 hours)
                                                                                               clean own cabin, shower ie bending,
                                                                                                  reaching, scrubbing, and wiping
                                                                                              Additional for supply vessels
                                                                                               handle cargo on the back deck of
                                                                                                  vessel
                                                                                               handle wires, chains and ropes during
                                                                                                  anchor handling
                                                                                               hook and unhook tows




    54                                                                                                                                                                  Order No. 22 of 1999
         MEDICAL FITNESS                                                                      APPENDIX 3                                                                          PART 9
         OF SEAFARERS                                                                         (continued)                                                                          Issue 5


                                                                             Table 4: Chief Cook/Cook/Steward

1. Vision                                        2. Hearing/speech       3. Consciousness           4. Physical                                        5. Other

    near vision for reading labels, menus,       give/take                alert to movements      lifting, carrying, unpacking stores from          order all food provisions
     recipes, computer, instructions, orders       instructions              of persons in            gangway or forehead store space
                                                                                                                                                        plan menus
     for stores, invoices, telexes, faxes                                    kitchen because of
                                                  use telephones to                                 unpack and place stores on shelves in fridges
                                                                             hot food in                                                                cooking all meals for all persons
    near vision for cutting, slicing, cooking     contact providores,                                and freezers from floor height to shoulder
                                                                             saucepans and                                                               on board
                                                   clients                                            height
                                                                             trays
                                                                                                                                                        work split shifts with early starts
                                                  communicate with                                  unpack cartons each trip eg soft drinks, cans,
                                                                            alert to position of                                                        plus additional hours for
                                                   ship‟s crew                                        foodstuffs, and cleaning gear
                                                                             deep fryers,                                                                administration and other
                                                  hear alarms               cooking pots, pans      cleaning pots and utensils                         paperwork
                                                                             especially in rough
                                                                             weather                 wiping benches, stove tops                        away at sea for up to 6 months
                                                                                                                                                         at a time although calling in at
                                                                            alert to hazards on     cleaning kitchen and laundries – mopping,
                                                                                                                                                         various ports during the voyage
                                                                             ship eg fire etc         scrubbing
                                                                                                                                                        fit through escape hatches
                                                                                                     scrub mats out of fridge
                                                                                                                                                        use a computer
                                                                                                     polish passageways
                                                                                                                                                        wear safety footwear
                                                                                                     standing for long periods (3 hours)
                                                                                                                                                        work in conditions involving
                                                                                                     fine manual dexterity to use kitchen utensils,
                                                                                                                                                         heavy rolling and pitching of
                                                                                                      knives and to turn knobs, flick switches on
                                                                                                                                                         vessel
                                                                                                      ovens, hot plates and appliances
                                                                                                     clean own cabin, shower ie bending, reaching,
                                                                                                      scrubbing, and wiping
                                                                                                     cleaning grease traps and tanks
                                                                                                     cleaning ovens and deep freezers
                                                                                                     narrow stairways




55                                                                                                                                                                       Order No. 22 of 1999
 PART 9                                                                            APPENDIX 3                                                              MEDICAL FITNESS
 Issue 5                                                                            (continued)                                                              OF SEAFARERS


                                                                        Table 5: Catering Attendant and Steward

     1. Vision                      2. Hearing/speech               3. Consciousness         4. Physical                                        5. Other

        near vision for:            give/take instructions        alert to movements of    general interior cleaning of ship eg portholes    assist Cook in food
         - reading labels                                            other persons in                                                             preparation as required
                                     hear alarms                                             daily vacuum of mess room
         - reading instructions                                      kitchen, pantry
                                                                                                                                                 work split shifts with early
         - cleaning floors,          communicate with ship‟s        because of hot           polishing mess room twice weekly and other
                                                                                                                                                  morning starts
           surfaces etc               crew and passengers            saucepans, food trays     floors weekly (3 levels in all)
                                                                     etc                                                                         away at sea for up to 6
      distinguish coloured light                                                             lifting, carrying, unpacking stores
                                                                                                                                                  months at a time although
       alarms/indicator lights on
       galley range                                                                           carrying hot trays and stocking pantry             calling in to various ports
                                                                                                                                                  during the voyage
                                                                                              lifting floor polishing machines (24kg) up
                                                                                               stairs (2 persons)                                fit through escape hatches
                                                                                              mopping, sweeping and/or vacuuming                wear safety footwear
                                                                                              wiping and scrubbing benches, deckheads,          work in conditions
                                                                                               bulkheads                                          involving heavy rolling and
                                                                                                                                                  pitching of vessel
                                                                                              working overhead, above shoulder height to
                                                                                               clean/wipe surfaces                               take an active role in all
                                                                                                                                                  vessel safety and emergency
                                                                                              washing dishes/pans in sink at waist height        drills
                                                                                              load/empty dishwasher – bending required          take an active role in crisis
                                                                                              washing/drying crew‟s bed linen and towels         management in emergencies
                                                                                               on crew change day
                                                                                              occasional cleaning of cabins when passengers
                                                                                               are on board
                                                                                              keeping washroom toilets clean on all levels
                                                                                              clean own cabin, shower ie bending, reaching,
                                                                                               scrubbing, and wiping
                                                                                              vacuum all carpet areas




56                                                                                                                                                          Order No. 22 of 1999
MEDICAL FITNESS                                                                                                     PART 9
OF SEAFARERS                                                                                                         Issue 5


                                                      Appendix 4
                                                           Forms
                                                         Form 1
                                        Certificate of Medical Fitness
Name

                                   LAST NAME                                                 FIRST NAMES


Sex:            Male               Female                Date of birth (day/month/year)
                                                                                                     /             /


Home address:



                          Kind of identity
Proof of identity:        (eg photo driver‟s                                                Number
                          licence/passport)

I have evaluated the above-named applicant according to Marine Orders, Part 9, made under the Navigation Act 1912.
On the basis of the applicant‟s personal declaration, my clinical examination and diagnostic test results recorded on the
medical examination form, I declare the applicant:

            Look-out duty            Deck Dept              Engine Dept             Catering Dept           Other services


Fit


Unfit



The applicant used aids to vision to meet a satisfactory standard                 YES                       NO


Date of last colour vision test if not tested at this examination


The applicant used aids to hearing to meet a satisfactory standard                YES                       NO


Describe any restrictions (eg specific position, type of ship, trade area) and/or any practical test required before fitness
can be assessed:




Order No. 22 of 1999                                                                                                           57
PART 9                                              APPENDIX 4                                MEDICAL FITNESS
Issue 4                                              (continued)                                OF SEAFARERS




Prescribed regular medications taken:




Action taken by Medical Inspector (eg referral)


Date of examination
                              /       /         Place of examination
 (day/month/year)


                                                                                                Official stamp
Name of Medical Inspector



Signature of Medical Inspector


Expiry date of Certificate
(day/month/year)

I acknowledge that I have been advised of the content of the medical examination form.


Applicant‟s signature



     The original of this Certificate is to be given to the applicant. A copy is to be provided to AMSA. The Medical
                                                 Inspector may retain a copy.




58                                                                                             Order No. 22 of 1999
MEDICAL FITNESS                                           APPENDIX 3                                                  PART 9
OF SEAFARERS                                               (continued)                                                 Issue 4


                                                              Form 2

                                                  Medical Statement
                                  for the purposes of certification under STCW

                                                   IMPORTANT NOTE

This document is NOT a Certificate of Medical Fitness and does NOT meet the requirements of Marine Orders,
Part 9, for a Certificate of Medical Fitness. It is intended solely to permit the holder to obtain a certificate under
Marine Orders, Part 3 in accordance with the International Convention on Standards of Training, Certification and
Watchkeeping for Seafarers, 1995.

Name
                             LAST NAME                                                FIRST NAMES

Sex:            Male                Female                     Date of birth (day/month/year)
                                                                                                        /             /

Home address:


                        Kind of identity
                                                                                            Number
Proof of identity:      (eg photo driver‟s licence/passport)

I have evaluated the above-named applicant according to Marine Orders, Part 9, made under the Navigation Act 1912. On
the basis of the applicant‟s personal declaration, my clinical examination and diagnostic test results recorded on the medical
examination form, I declare that:
     ●         the applicant is NOT medically fit to perform duties as a seafarer or as a coastal pilot on a ship, because of a
               temporary/permanent condition or disability
     ●         the applicant cannot be certificated as medically fit as a full medical examination has not been carried out
     ●         the applicant meets the standards in Marine Orders, Part 9, relating to eyesight, colour vision and hearing
Date of examination
                                           /          /             Place of examination
(day/month/year)


Date of last colour vision test if not tested at this examination


Name of Medical Inspector                                                                            Official stamp


Signature of Medical Inspector

Expiry date of certificate
                                                  /       /
(day/month/year)

I acknowledge that I have been advised of the content of the medical examination form.

Applicant‟s signature


   The original of this certificate is to be given to the applicant. A copy is to be provided to AMSA. The Medical
                                                Inspector may retain a copy.




Order No. 22 of 1999                                                                                                       59
PART 9                                                                MEDICAL FITNESS
Issue 5                                                                 OF SEAFARERS




                                       Appendix 5

                      Guidance in screening for colour vision
1 Need for good colour vision

1.1 Deck officers need to be able to distinguish red, green and white navigation lights
in order to be able to make correct decisions regarding the aspect of an approaching
vessel, and regarding what action needs to be taken, if any, to avoid a collision.
Confusion between such lights would lead to incorrect decisions being taken, with the
potential for collision and resultant deaths, injuries and loss.

1.2 Ratings on lookout duty similarly need to be able to distinguish red, green and
white navigation lights in order to provide correct advice to the officer of the watch.

1.3 Engineering officers and ratings on engineroom duty need to be able to distinguish
both warning lights (normally coloured red) from correct status lights (normally
coloured white or green) and also need to be able to distinguish the colours of electrical
wires when making connexions.

2 Tests

2.1 The Ishihara pseudoisochromatic tests should be used to screen seafarers in the
deck and engine departments for colour vision impairment. If the tests indicate
impaired colour vision, further testing should be carried out.

2.2 In the case of persons in the deck department who are required to keep watches, the
further test should use the Holmes-Wright Type B lantern test. This test is conducted
by some ophthalmologists and the Schools of Optometry in various Universities.

2.3 In the case of persons in the engine department whose duties may include making
electrical connexions, the further test should be the UK Electricity Supply Industry
Colour Vision Trade Test.

     Note: For information on where to refer seafarers with colour vision deficiencies,
     contact the Manager, Ship Operations and Qualification at the Australian
     Maritime Safety Authority, on 1800 021 098.




60                                                                      Order No. 22 of 1999
MEDICAL FITNESS                        APPENDIX 5                                   PART 9
OF SEAFARERS                            (continued)                                  Issue 4


3 Ishihara Test

3.1 The Ishihara pseudoisochromatic tests (using either the full set of 38 plates or the
abridged version of 24 plates) should be used.

3.2 A satisfactory response on all plates on the first showing, or a single wrong
response on first showing which is corrected on a second or third showing, should be
considered to indicate „Normal‟ colour vision. If the tests indicate impaired colour
vision, further testing should be carried out.

4 Holmes Wright Type B Lantern Test

4.1 The lantern test is a practical test of a person's ability, in conditions simulated to
represent a watchkeeping situation, to recognise and discriminate between navigation
lights used at sea.

4.2 A lantern test is conducted by means of a Holmes/Wright type B lantern, which
projects red, green and white lights viewed indirectly through a polished mirror at a
virtual distance of 6 metres from the eyes. The large aperture of the lantern projects one
coloured light at a time and the small apertures project 2 coloured lights side by side at
a time. Each full circuit of the lantern contains 9 settings of single large apertures or 9
settings of small apertures. The small apertures of the lantern show any combination of
2 of the 3 colours.

4.3 A person who uses an aid to vision for a letter test is required to use the same aid to
vision in the lantern test.

4.4 A person who does not use an aid to vision for a letter test is not permitted to use
an aid to vision in the lantern test.

4.5 A person undergoing the lantern test must not wear a tinted aid to vision for the
purpose of passing the test.

4.6 The lantern test must be conducted in a room from which daylight is excluded.

4.7 A person who requires to adapt to conditions of darkness is to be allowed up to 10
minutes complete or partial darkness in preparation for the lantern test.

4.8 A person is considered to have passed the lantern test if he or she correctly names
the colours of one full circuit of large apertures, 4 full circuits of small apertures shown
in sequence, and 9 sets of small apertures shown at random:




Order No. 22 of 1999                                                                     61
PART 9                                 APPENDIX 5                       MEDICAL FITNESS
Issue 4                                 (continued)                       OF SEAFARERS


4.9 The procedures specified in 4.10 to 4.16 should be followed if a person
undertaking the lantern test fails to achieve a pass in accordance with 4.8.

4.10 At the first mistake in naming a colour correctly, the examiner must inform the
person being tested of the mistake and continue the test, adding a further circuit.

4.11 1f no further mistake is made in the test and the further circuit, the person being
tested will be considered to have passed.

4.12 If a second mistake is made, the procedure under 4.10 and 4.11 of this Appendix
is to be repeated.

4.13 If a third mistake is made, the test is to be repeated from the start after the person
being tested has been given the opportunity to rest his or her eyes or regain composure.

4.14 In repeating the test under 4.13, the examiner is to record the result but not inform
the person being tested of mistakes being made.

4.15 A person who in the repeated test under 4.13, correctly names all colours in
accordance with 4.8 will be considered to have passed.

4.16 A mistake of red for green or green for red in the repeated test under 4.13 means
failure of the lantern test.

4.17 A person who has failed the lantern test may request a further test.

5 Colour Vision Trade Test

5.1 When mistakes are made on the Ishihara pseudoisochromatic plates, this test
should be used.

5.2 The applicant should sit opposite the Medical Inspector in good natural light. One
at a time, each of the coloured wires should be placed in front of the applicant on a flat
surface. The applicant should be asked to identify the colour of the wire. Slowness in
answering indicates difficulties. Care must be taken that the applicant cannot compare
the colour of one wire with others.

5.3 Applicants who wrongly identify a colour should be given an individual wire. The
candidate should be asked to indicate when there is a match. All nine colours should be
tested in this way.

5.4 Failure to find a correct match shows unreliable colour vision.

5.5 Matching colours correctly but wrongly identifying them singly, means mistakes
will be made in identifying certain colours without comparing them with others.

62                                                                       Order No. 22 of 1999
MEDICAL FITNESS                        APPENDIX 5                                 PART 9
OF SEAFARERS                            (continued)                                Issue 4


5.6 The apparatus required is:
      One centimetre of coloured plastic covered wire is exposed on a white card
       housed in a photographic colour transparency slide, size 5 x 5 cm, with a viewing
       window of 3.5 x 2.5 cm. Two complete sets of colours are made up (18 slides),
       these being housed in a slide magazine.
      For matching purposes 9 individual wires are to be available, one in each colour,
       each 2.5 cm long.
      Nine colours are to be used: white, black, yellow, red, grey, blue, orange, green
       and brown.
      All wires used should have the same diameter, which should be in the range 0.8
       to 1.1 mm. Wire of 0.89 mm diameter is preferred, if available.

                                        ******




Order No. 22 of 1999                                                                   63

								
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